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NICE guideline 8: Managing resectable (operable) and borderline resectable pancreatic cancer

Resectable (operable) cancer is cancer that can be removed by surgery.

Sometimes the cancer may grow very close to the major blood vessels near the pancreas. This is called borderline resectable pancreatic cancer. It may be possible to remove the cancer, but it depends which blood vessels are affected and how far the cancer has grown.

Treatment before surgery (neoadjuvant treatment)

8.1 If you have borderline resectable pancreatic cancer, chemotherapy before surgery  should only be considered as part of a clinical trial.

8.2 If you have pancreatic cancer that can be removed with surgery (operable cancer), chemotherapy before surgery should only be considered as part of a clinical trial. 

Read more about clinical trials.

Surgery

8.3 If you are having surgery to remove cancer in the head of the pancreas, your doctor should consider pylorus-preserving surgery, as long as it removes all the cancer. 

Pylorus-preserving surgery doesn’t remove part of the stomach or the stomach valve (the pylorus).

Read more about surgery to remove pancreatic cancer.

Chemotherapy after surgery (adjuvant treatment)

8.4 You should be given time to recover from surgery before starting chemotherapy. Chemotherapy should be started as soon as you are well enough to cope with six months of chemotherapy (six cycles).

8.5 You should be offered gemcitabine chemotherapy with capecitabine (GemCap) following surgery, once you have recovered from the surgery.

8.6 If you are not well enough to cope with GemCap following surgery, your doctor should consider gemcitabine alone. This may have fewer side effects, but it may still help you live longer.

Read more about chemotherapy.

Follow-up after surgery to remove pancreatic cancer 

8.7 You should have regular check-ups with the specialist team following surgery, to manage any side effects or problems from the surgery.

8.8 If you get new or unexplained symptoms following treatment, these should be investigated by the specialist team and you should be offered services to support you.

Read more about surgery to remove pancreatic cancer and chemotherapy.

Read other sections of the NICE guidelines for pancreatic cancer:

Information Standard

Published: August 2018

Review date: August 2020