Chapter Four: When Surgery is an Option
Tuesday, March 8, 2022
Late last week I was finally able to have the balance of my thyroid surgically removed. My surgeon performed a partial thyroidectomy, which removed the rest of my thyroid. It was a very safe, short procedure: the incision was only about an inch and a half, the surgery itself took about an hour, and I only had to stay one night in the hospital to ensure that there was no damage to my vocal cords.
My medical team watched for potential complications like bleeding and infection – which are risks with many surgeries – and nerve damage that could cause a permanently hoarse or weak voice. Another potential complication was hypoparathyroidism, which can cause tingling, numbness, or cramping, and can occur if there is surgical damage to or removal of the parathyroid glands, which are behind the thyroid and regulate blood calcium. Although the idea of surgery can be stressful regardless of what the operation entails, I felt confident going into my procedure knowing that it would be relatively quick and straightforward, and am happy to now be recovering at home.
In my regular conversations with pancreatic cancer patients and caregivers, I hear many wish that surgical treatment was a possibility. Only 10-20% of pancreatic cancer patients are diagnosed in time to be eligible for surgery, which is still the only curative strategy for this disease. Fortunately for both Richard and Céleste*, a Whipple surgery is part of their treatment plan.
One of the most common pancreatic cancer surgeries, a Whipple procedure is an extensive operation that usually takes between four and eight hours to complete, though in some cases it can take up to 14 hours. Such a long and complex procedure can take time to schedule and get the right team in place, which can sometimes include a transplant surgeon for their expertise working with veins and arteries.
The surgery begins with an incision lengthwise down the abdomen, or in a slight v-shape near the ribs. During the procedure the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum (the uppermost part of the small intestine), a small portion of the stomach called the antrum, and lymph nodes near the head of the pancreas. If the surgeon begins only to discover that the cancer has spread, the Whipple procedure will no longer be performed.
Following surgery, patients stay in the hospital between 6-10 days to be monitored while they recover. Because this surgery is so intricate, there are more risks to consider: 10-20% of patients may experience bleeding or infection, and fewer still may have a blood clot or a pulmonary embolism. As with many major surgeries, there is also a small risk of death. For most patients, the part of the pancreas that remains after the Whipple procedure is enough to maintain the hormones that prevent diabetes, but diabetes remains a risk factor for patients after surgery, and those who are already diabetic may have increased symptoms. As you can see, there is a lot for patients to consider when they are eligible for surgery, but the majority choose to move forward knowing that it will give them their greatest chance at disease-free survival.
I look forward to updating you on how I am recovering, as well as how Richard and Céleste are doing following their Whipple procedures. If you or a loved one have been diagnosed with pancreatic cancer and are eligible for a Whipple or other surgical procedure, we recommend seeking out a surgeon who has experience with this complex operation. You should feel empowered to ask how many times they have performed the surgery, or to be referred to a high-volume treatment centre where experienced surgical teams do these procedures regularly. Click here for more questions to ask your doctor.
*Pancreatic cancer can be an intensely personal experience, particularly when a patient is still undergoing treatment. With this in mind, we have gathered the experiences of several patients navigating a stage II pancreatic cancer diagnosis, and will present them here in the coming weeks as the story of Céleste.