Pancreatic Cancer: Surgery
Surgery can sometimes be used to treat pancreatic cancer. Different kinds of surgery
may be done. The type you have depends on where the cancer is, how much it has spread,
the goal of surgery, and other factors.
When might surgery be used for pancreatic cancer?
Surgery is sometimes an option to try to remove all of the cancer if it’s still small
and hasn't spread (early stage). In most cases, pancreatic cancer has spread too far
by the time it’s found to remove it all. For more advanced cancers, surgery can sometimes
be used to help prevent or relieve symptoms.
If your healthcare provider recommends surgery, be sure you understand the goal of
the surgery. Is it to try to cure your cancer or is there a different goal? Surgery
for pancreatic cancer is complex. It can cause major side effects, so it’s important
that you are healthy enough for it and you know what to expect. You should have it
done at a center that has a lot of experience treating this cancer.
Types of surgery for pancreatic cancer
Surgery to determine the extent of the cancer
Staging laparoscopy
Surgery to remove pancreatic cancer is a major surgery. It’s very important to know
just how far the cancer has spread before attempting this type of surgery. Sometimes
it can be hard to tell how far the cancer has spread based on imaging tests alone.
So, your healthcare provider may recommend laparoscopic surgery first. This can give
your healthcare team a better idea of exactly how far the cancer has spread. This
can help them decide if surgery to remove the cancer might be an option.
For this surgery, your surgeon makes several small cuts (incisions) in the skin over
your abdomen (belly). Long, thin tools, one of which has a small video camera on the
end, are put into your body through these incisions. This lets the surgeon look at
your pancreas and nearby organs. They can also take biopsy samples to see how far
the cancer has spread.
Surgery to try to remove all of the cancer
Whipple procedure (pancreaticoduodenectomy)
This is the most common surgery for removing tumors from the pancreas. It’s used for
cancers in the head of the pancreas. In this complex surgery, your surgeon removes:
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Head of your pancreas, and sometimes the body of the pancreas as well
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Duodenum (first part of the small intestine)
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Sometimes part of your stomach
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Gallbladder and part of the common bile duct
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Sometimes nearby lymph nodes
After this surgery, bile from your liver, food from your stomach, and digestive juices
from the remaining part of your pancreas all go right into your small intestine. You
can still digest foods, but some people might need to take pancreatic enzyme pills
to help with this.
Total pancreatectomy
You may have this surgery if the cancer has spread through your pancreas, but not
beyond it. This is done much less often than the other types of surgery. In this surgery,
your surgeon removes the:
Once your surgeon removes your pancreas, you won’t be able to make pancreatic juices
or insulin. You’ll have diabetes, so you’ll need to test your blood sugar levels,
give yourself insulin shots, and take other steps to keep your blood sugar in check.
You’ll also need to take pancreatic enzyme pills to aid in digestion when you eat.
Distal pancreatectomy
This surgery might be an option if the cancer is only in the tail of your pancreas.
For this surgery, your surgeon removes only the tail of your pancreas. They may also
take out part of its body, the middle section, and your spleen. This surgery is seldom
done because tumors in the tail of the pancreas have usually spread by the time they’re
found.
Palliative procedures
For more advanced cancers, sometimes other procedures can help with certain symptoms.
But these surgeries cannot cure the cancer. They may help restore bile flow, allow
food to leave your stomach and go into your small intestine, or ease pain.
For instance, surgery may relieve a blocked bile duct by creating a new path around
it. Surgery may also relieve a blockage where your stomach connects to the first part
of your small intestine by bypassing it. Another option for blockages like these is
to put in a stent. This is a metal or plastic tube that's pushed through the blockage.
It keeps the passageway open so fluid and food can flow through like they're supposed
to.
These are some other kinds of palliative surgery:
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Surgery to redirect the flow of bile so it goes right into your small intestine
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Surgery to allow your stomach to empty into another part of your small intestine
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Injections to block or numb nerves near your pancreas to prevent or relieve pain
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Cutting nerves near your pancreas to prevent or relieve pain
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Putting a tube through your skin and into your belly to drain fluid (percutaneous
drainage)
Possible risks, complications, and side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Risks from surgery for pancreatic cancer
Along with the risks above, pancreatic cancer surgery can sometimes cause other problems.
Infection
Pancreatic cancer surgery increases your risk for infection. Healthcare providers
can treat some skin infections by allowing them to drain and by using clean dressings.
More serious infections can occur inside your abdomen (belly). These may lead to more
surgery. Antibiotics are often very helpful in treating infections.
Anastomotic leak
After your surgeon removes parts of your stomach, intestines, or bile ducts, the surgeon
attaches them back together. Leaks can sometimes occur at these spots. If the leak
is small, treatment may include observation and changes in your diet. This lets the
leak heal itself over time. If the leak is large, it can be life-threatening. You'll
need surgery to repair the leak.
Changes in bowel function and what you can eat
Some people might need to take enzyme pills or change their diets. They might also
have different bowel patterns after surgery.
Diabetes
If a large part or your entire pancreas is removed, you might have trouble controlling
your blood sugar levels. You might need to take insulin.
Getting ready for your surgery
Before surgery, you’ll meet with a surgeon to talk about it. At this time, ask any
questions and share concerns you may have. This is also a good time to review the
side effects of the surgery and talk about its risks. You might ask if the surgery
will leave scars and what those scars will look like. You might also want to ask when
you can expect to return to your normal activities. After you have talked about all
the details with your surgeon, you’ll sign a surgical consent form that gives permission
to your healthcare provider to do the surgery.
A few days before your surgery, your healthcare provider might give you laxatives
and enemas to help clean out your colon. They will tell you when and how to use these.
You may also be told to follow a special diet.
On the day of your surgery, you should arrive at the hospital admission area a couple
of hours before the time your surgery is set to start. There, you'll complete the
needed paperwork and go to a pre-operative area. There, you’ll undress and put on
a hospital gown. During this time, your healthcare team will ask you about your health
history. They’ll also ask about medicine allergies and talk about the procedure. Try
not to get frustrated by the repetition. These questions are repeated to help prevent
mistakes.
While you’re in the pre-operative area, an anesthesiologist or a nurse anesthetist
will evaluate you. They will also explain the anesthesia you’ll get during surgery.
The purpose of the anesthesia is to put you to sleep so that you won't feel any pain.
Be sure to answer all the questions thoroughly and honestly. This helps prevent complications.
Also, ask any questions you have about your anesthesia. You'll sign an anesthesia
consent form that states that you understand the risks and give permission to administer
anesthesia.
Your surgeon will also see you in the pre-operative area. You can ask any last-minute
questions you have. This can help put your mind at ease.
What to expect during surgery
When it’s time for your surgery, you’ll be taken into the operating room. There will
be many people there. These include the anesthesiologist, surgeon, and nurses. Everyone
will be wearing a surgical gown and a face mask. Once in the room, someone will move
you onto the operating table. If it hasn't already been done, your anesthesiologist
or nurse will put an intravenous line (IV) into your arm. This requires just a small
skin prick. Someone will put special compression stockings on your legs to help prevent
blood clots. EKG (electrocardiogram) wires with small, sticky pads on the end will
be attached to your chest. This is done to monitor your heart. You’ll also have a
blood pressure cuff wrapped around your arm.
During surgery, a small catheter may be placed through your urethra and into your
bladder. This is a soft, hollow tube that drains your urine into a bag. You’ll also
have a breathing tube put in your windpipe (trachea). A breathing machine (ventilator)
will control your breathing. A nasogastric tube may be put in your nose. This is a
suction tube that goes through your esophagus and into your stomach to drain out stomach
contents.
What's removed during surgery and where the incisions (cuts) depend on the type of
surgery you have. This is based on where the tumor is.
After surgery, you'll be moved to the post anesthesia care unit (PACU). There, your
healthcare providers will monitor your condition for about 1 to 2 hours. When you
wake up, don't be alarmed by the number of tubes and wires attached to you. These
are normal after surgery. When you’re fully awake and stable in the PACU, your family
may be able to see you for a short time. Soon after that, if you remain awake and
stable, the staff will move you to a regular hospital room.
What to expect after surgery
Your hospital stay will depend on the type of surgery you had. Recovery after you
leave the hospital may take a month or more.
For the first few days in the hospital after surgery, you’re likely to have pain.
It can be controlled with medicine. Your healthcare provider will prescribe this for
you. You may have an epidural catheter in your lower back so that it’s easier to give
you pain medicine. You may have a patient-controlled analgesia pump (PCA). This is
an IV form of pain medicine programmed so that you may control it by pressing a button.
Before you leave the hospital, your healthcare provider will start you on an oral
pain medicine instead. Talk with your healthcare team about your options for pain
relief. Some people are hesitant to take pain medicine, but doing so can help you
heal and recover. If your pain is not controlled well, for instance, you may not want
to cough or get out of bed. You need to do these things to help prevent problems like
pneumonia and blood clots.
Your healthcare provider may have put a small tube (called a drain) in your lower
stomach during surgery. There may be more than 1. You may go home with 1 or more drains
still in place. If so, you will be taught how to care for them.
You may feel tired or weak for many months. The amount of time it takes to heal is
different for each person.
You may have constipation from using pain medicine, not moving around, or not eating
or drinking very much. Talk with your healthcare provider about how to prevent and
treat constipation if it occurs.
If your entire pancreas was removed, you no longer make insulin. This leads to diabetes.
You’ll need to learn how to test your blood sugar and to give yourself insulin shots.
The diabetes specialist will help you learn to manage diabetes. They will teach you
about the diet you should follow, how to test your blood sugar, and how to keep your
blood sugar levels within a normal range.
If your surgeon removed your pancreas, or it can no longer make enzymes, you may need
to take digestive enzyme pills when you eat. These help you digest food.
You’ll also need follow-up care after surgery. Make an appointment with your surgeon
and get any other information for home care and follow-up when you leave the hospital.
Be sure you know what to do and understand all the instructions you're given.
Your healthcare provider will also talk with you about when to call. You may be told
to call if you have any of the below:
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New pain or pain that gets worse
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Signs of an infection, such as a fever or chills
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Wound problems
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Trouble controlling your blood sugar
Ask your healthcare provider what signs to watch for and when to call. Know how to
get help after office hours and on weekends and holidays.
Talk to your healthcare team
If you have any questions about your surgery, talk to your healthcare team. They can
help you know what to expect before, during, and after your surgery.