Surgery for pancreatic cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Some people with pancreatic cancer have surgery. The type of surgery you have, or whether you can have surgery at all, depends on aspects of the cancer including its stage, if it has spread, and the size and location of the tumour in the pancreas. When planning surgery, your healthcare team will also consider other factors, such as your age, overall health and any other treatments you may have had for pancreatic cancer.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. You may have surgery to:

• try to completely remove the tumour
• reduce pain or ease symptoms (called palliative surgery)

Sometimes a tumour may look resectable until doctors start surgery to remove it. They may find that because of the location of the tumour or because it grew or spread (metastasized), it can't actually be removed. If the surgeon finds that the tumour is unresectable in the middle of surgery, they may stop the surgery or transition to doing a palliative surgery to relieve the symptoms of pancreatic cancer instead.

The following types of surgery are used to treat pancreatic cancer.

A Whipple procedure and reconstruction is usually done by open surgery, but it can also be done by laparoscopy or robot-assisted surgery.

The Whipple procedure is a long and complex surgery that can only be done by very experienced surgeons. A Whipple procedure may not be available at all treatment centres or hospitals.

Find out more about the Whipple procedure.

The kind of Whipple procedure done to remove a pancreatic tumour is based on the surgeon's opinion, the size of the tumour and its location in the pancreas. The outcomes and side effects of the Whipple procedure and modified Whipple procedure are typically the same.

Find out more about the modified Whipple procedure.

If you have a distal pancreatectomy, you will need to have certain vaccinations to replace the function of the spleen.

Because there is no remaining pancreas after a total pancreatectomy, you will need to take medicines (including insulin and digestive enzyme replacements) for the rest of your life to replace the essential functions of the pancreas if you have this surgery. You will also need to have certain vaccinations to replace the function of the spleen. Find out more about supportive care for pancreatic cancer.

For unresectable or recurrent pancreatic cancer, you may be offered a palliative procedure.

Tumours in the head of the pancreas often block the common bile duct or the duodenum. Palliative procedures are used to control symptoms caused by these blocks and improve quality of life. The procedure done depends on several factors including your predicted prognosis, what part of the pancreas the tumour is in and your overall health.

Most people will have the following palliative procedures endoscopically or percutaneously. Although they can be done during surgery (called palliative surgery), palliative surgery is less common today than it once was.

You may be offered a stent if your bile duct or duodenum is blocked by a tumour in the head of the pancreas that cannot be removed.

A stent is a small metal or plastic tube placed into the bile duct or duodenum that helps keep the duct or intestine open and allows for things to flow through them normally. The most common way to place a stent to relieve a bile duct or duodenal blockage is through an ERCP (endoscopic retrograde cholangiopancreatography). In some cases, stents are placed percutaneously or during another surgery instead.

If you have a blockage of the bile duct or duodenum caused by a tumour in the head of the pancreas, you may be offered a bypass procedure. A bypass procedure creates a path around the blockage so food or bile can flow normally into the small intestine.

A biliary bypass creates a path for bile to flow around a blockage in the bile duct. The path that the surgeon creates depends on the location of the blockage. A biliary bypass is done through open surgery.

A biliary bypass is used far less often than stent placement. It may be preferred to a stent:

• for patients expected to live with unresectable pancreatic cancer for one or more years
• if the surgeon wants to treat the nerves around the pancreas to relieve pain
• to avoid having to do multiple procedures when a surgery was started or needed for another reason

A gastric bypass( also called a gastrojejunostomy, or enteric bypass) creates a path for partially digested food from the stomach to flow around a blockage in the duodenum. The surgeon connects the pylorus to the jejunum (the second segment of the small intestine). A gastric bypass is done through open surgery.

Some people will have both a gastric bypass and bile duct stent.

Side effects of surgery will depend mainly on the type of surgery, what tissues are removed and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for pancreatic cancer may cause these side effects:

• pain
• indigestion or difficulty digesting certain foods
• difficulty absorbing nutrients (malabsorption)
• weight loss
• bowel changes, such as diarrhea, constipation, or stools that are large, pale or light-coloured, smell very foul and float in the toilet
• delayed gastric emptying
• dumping syndrome
• leaking of bile, stomach acid or pancreatic juices from the site where the remainder of the pancreas, stomach, bile duct and small intestine were reattached during surgery
• a fistula between your pancreas and abdominal cavity (the hollow part in the abdomen)
• diabetes

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.