Surgery is the best option for people whose cancer can be safely and effectively removed. This usually means that the tumor has not grown into any of the major blood vessels located near the pancreas or spread to surrounding structures. The type of surgery will depend on the location of the tumour in the pancreas. However, not every patient is eligible for surgical treatment. Factors such as the stage of the disease, personal health, and the ability to tolerate a major operation – including prolonged anesthesia – must be considered before a patient can undergo surgery.
It is important to discuss the benefits, risks, and potential complications of surgery with an experienced pancreatic surgeon before deciding upon surgery as the preferred course of treatment.
Although improvements in diagnosis, staging, surgical techniques, and postoperative care have led to better outcomes after surgery, pancreatic resection is a demanding operation on both the patient and the surgical team. Recent studies have shown that the outcome from surgery in these complex procedures is dependent on the experience of the hospital and the surgeon performing the operation. Therefore, Pancreatic Cancer Canada recommends that pancreatic cancer surgery be performed in a centre that is experienced and does a high volume of these complex surgical procedures to ensure the best outcome.
More information on Canadian high-volume centres can be found here.
Types of surgeries
The Whipple procedure is the most commonly performed surgery to remove tumours in the pancreas. In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, part of the duodenum(uppermost portion of the small intestine), a small portion of the stomach called the antrum, and the lymph nodes near the head of the pancreas. The surgeon then reconnects the remaining pancreas and digestive organs so that pancreatic digestive enzymes, bile, and stomach contents will flow into the small intestine during digestion. Surgery usually lasts between 6-10 hours.
A total pancreatectomy involves the removal of the entire pancreas, as well as the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. By removing the pancreas, the chance of removing the entire tumor is increased. Unfortunately, a total pancreatectomy leaves the patient unable to produce pancreatic enzymes for digestion and insulin to control blood glucose levels. The patient will be required to take supplemental enzymes and insulin for the remainder of his or her life. Sometimes, an islet cell transplant can be performed to allow the body to continue to produce insulin.
A distal pancreatectomy involves the removal of the bottom half of the pancreas. This procedure is chosen if the tumour is located in the body or tail of the pancreas.
Palliative Intent Surgery
Palliative intent surgery is sometimes recommended to alleviate distressing symptoms. In particular, tumours blocking the bile duct can cause uncomfortable symptoms such as jaundice, itching, nausea, and bowel problems. Common options for these procedures include:
Stent Implant – having a small plastic tube (called a stent) fitted inside the bile duct helps to open up the duct and help to improve symptoms.
Biliary Bypass – another method to relieve the blockage of the bile duct is to cut the duct above the blockage and rejoin it to the intestine. After the surgery, bile will bypass all or part of your bile duct and drain into the intestine.