Surgery

Surgery to remove a tumor offers the best chance for long term control of all types of pancreatic cancer.  If a tumor is able to be surgically removed, it is called resectable.  About 15-20% of patients with pancreatic adenocarcinoma have tumors which are considered surgically resectable.

When is surgery used?
In general, a pancreatic tumor is considered resectable if it has not spread beyond the pancreas and does not involve major arteries. If veins are involved, a qualified surgeon may be able to perform a vein resection. A vein resection typically adds an extra 60-90 minutes to the length of the surgery.
Determining a patient’s eligibility for surgery is not always easy. Even sophisticated imaging tests may not provide a perfect picture of the tumor. In some cases, during surgery, the surgeon will find that the cancer has spread and the operation will be ended. If surgery to remove the tumor is not possible, palliative procedures may be considered.

How should I choose my surgeon?
Pancreatic surgery is very complicated, especially the most common surgery, the Whipple procedure.  It is important to seek out a surgeon at a hospital that does a high volume, or large number, of these procedures.  Studies show that patients who undergo pancreatic surgery performed by an experienced surgeon have fewer complications and better outcomes.  When finding a surgeon, it is encouraged to ask how many pancreatic surgeries he or she performs each year.

The Pancreatic Cancer Action Network’s Patient and Liaison Services (PALS) Associates can provide patients and families with a listing of institutions and doctors who perform a high volume of pancreatic surgeries.  PALS Associates can also provide research articles supporting the benefits of getting pancreatic surgery at a high-volume institution.

What are the different types of pancreatic surgeries?
Different types of surgery are performed depending on the location of the tumor within the pancreas:

Whipple procedure (pancreaticoduodenectomy)
Distal pancreatectomy
Total pancreatectomy

How will I feel after undergoing pancreatic surgery?
After pancreatic surgery, it can take a patient anywhere from a few months to a year to feel relatively “normal” again.  It takes time for the digestive system to start working again and some patients find that they must make permanent changes in their diet to ease symptoms such as diarrhea, gas, and stomach pain.

Are surgeries for pancreatic cancer usually given with other treatments?
Sometimes treatment is given before surgery is performed to remove a pancreatic tumor. This treatment, called neoadjuvant therapy, generally involves chemotherapy, radiation therapy, or both. The goal of neoadjuvant treatment is to reduce the size of the tumor so that it is more easily removed during surgery. If blood vessels, such as veins and arteries, are affected by the tumor, neoadjuvant therapy may improve the chances for a complete surgical removal.

Often, adjuvant therapy, or treatment that is given after the surgical removal of all or part of the pancreatic tumor is given. After surgery, patients are at risk for recurrence, or reappearance, of the cancer. Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery. The aim of adjuvant therapy is to kill microscopic cancer cells that may be present when their numbers are small, thereby preventing recurrence of a tumor.

Clinical trials may be available for pancreatic cancer patients seeking adjuvant therapy. When considering participation in an adjuvant therapy clinical trial, it is important to note that usually adjuvant therapy clinical trials limit the length of time after surgery that patients can wait before participating in the trial. Typically, patients have to start treatment on an adjuvant therapy clinical trial within two to three months after surgery. Therefore, patients considering participation in an adjuvant clinical trial should learn about their options either before surgery, or immediately following.

The Pancreatic Cancer Action Network recommends that all patients consider clinical trials when exploring treatment options. Clinical trials provide access to new, potentially better treatments and advance research. The Patient and Liaison Services (PALS) program maintains a comprehensive and up-to-date database of pancreatic cancer clinical trials.

What are palliative surgeries for pancreatic cancer?
Palliative procedures are performed to alleviate (palliate) symptoms. They do not involve the complete removal of the tumor. Palliative procedures may relieve symptoms of jaundice, pain, nausea and vomiting that are caused by blockage of the bile duct and/or duodenum. The most common palliative procedures for pancreatic cancer are biliary bypass surgery, gastric bypass surgery, stent insertion and celiac plexus block.

Biliary bypass and Gastric bypass
Stent Placement
Celiac Plexus

 

 

Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note that any personal information you provide to PanCAN’s associates during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and treatment efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so.