Surgery for pancreatic cancer

Surgical treatment for pancreatic cancer falls into two main categories. Firstly surgery can be performed to completely remove the cancer, and secondly where surgery is necessary to help alleviate symptoms.

Removing the cancer - Curative surgery

If the tumour is small (usually less than 3 cm across), there are no signs that it has spread, and you are fit and healthy, surgery is considered the most effective treatment option. Unfortunately this usually only applies to about 15 to 20 out of 100 patients (15 - 20%).

This is considered a major operation and will only be done by a specialist who is trained and experienced in pancreatic surgery. You will probably need to be referred to a regional pancreatic cancer surgical centre where the team get to treat between 100 - 200 pancreatic cancer patients a year. Click here to find out where your nearest centre is.

Depending on where the cancer is and how much of the pancreas is involved, potentially all or just part of the pancreas will be removed:

  • Whipple's operation - involves the removal of the head of the pancreas, the lower end of the stomach, most of the duodenum (first part of the small intestines), the common bile duct, gall bladder and the surrounding lymph nodes. The remaining part of the stomach, bile duct and pancreas are then reattached to the small intestines.
  • Pylorus-preserving pancreatoduodenectomy - occasionally it is not necessary to remove the lower end of the stomach thus preserving the stomach valve (the pylorus) that empties into the small intestines.
  • Distal pancreatectomy - also called 'left' pancreatectomy, it is performed on the tail end or body of the pancreas which is furthest away from the join to the duodenum
  • Total pancreatectomy - sometimes it is necessary to remove the whole pancreas if there is a large cystic or endocrine tumour

Surgery for helping with symptoms of pancreatic cancer - Palliative surgery

If the cancer has spread and cannot be removed, there are a number of operations that might be recommended by your doctor to help alleviate some of the symptoms of the disease. The most common symptoms which need surgical intervention are jaundice, bowel obstruction and pain.

Jaundice

This is caused when the cancer is blocking the bile duct and can lead to a number of symptoms including:

  • Yellowing of skin and eyes
  • Feeling sick
  • Itchy skin
  • Altered bowel habits (wind and even pale smelly stools)
  • Feeling weak and a general lack of energy

The blockage in the duct can be treated a number of ways:

  • Insertion of a plastic or metal tube called a stent - Usually this can be inserted endoscopically while the patient is sedated. See the section on ERCP - Endoscopic Retrograde Cholangio-Pancreatography in the diagnosis section for more information.
  • Biliary bypass - if placing a stent is not possible, an operation that allows the bile to drain away by bypassing the blockage can be performed. Also known as a choledocho-jejunostomy it is where the bile duct is cut above the blockage and then reattached directly into the small intestines.

Bowel obstruction

The upper part of the small intestines - the duodenum - can become blocked by the tumour. This will cause a number of symptoms including:

  • Feeling of sickness after eating
  • Vomiting after eating which provides relief from the symptoms
  • Weight loss

This blockage is quite common and can be relieved by an operation known as a:

  • Gastric bypass - where the duodenum below the blockage is attached directly to the stomach allowing the food to pass through into the bowels.

Control of pain

If you have pain that is difficult to control with other therapies (drugs or radiotherapy) it may be possible to treat the pain by blocking the nerves that supply the pancreas.

  • Coeliac plexus nerve block - the nerves from the pancreas collect just behind it in a thick bundle called the Coeliac Plexus. By injecting a special chemical directly into this nerve plexus you may receive pain relief. The operation is usually carried out under sedation in which you receive an injection in your arm or the back of your hand that makes you drowsy and relaxed but does not put you to 'sleep'. Then with the aid of a CT scan or an EUS the doctor can inject the chemical into the nerve plexus.