Whipple's procedure and other types of surgery to remove pancreatic cancer
There are several different operations for pancreatic cancer. They involve removing all or part of the pancreas, and other organs and tissues around it such as part of the stomach or duodenum (first part of the small intestine).
Your surgeon will discuss the best type of surgery for you. This will depend on where the cancer is in the pancreas and how much of the pancreas is affected. The different types of surgery are:
- Whipple’s procedure
- Pylorus-preserving pancreaticoduodenectomy (PPPD)
- Distal pancreatectomy
- Total pancreatectomy
- Removing part of a vein
The Whipple’s procedure is an operation. It is one of the most common types of surgery for pancreatic cancer. It is usually used for tumours in the head or neck of the pancreas that haven’t spread beyond the pancreas.
The surgeon will remove the head of the pancreas. They also remove:
- the lower end of the stomach
- the duodenum (first part of the small intestine)
- the gall bladder (which stores a fluid called bile that helps digestion)
- part of the bile duct (which carries bile from the liver to the duodenum)
- surrounding lymph nodes (part of the immune system).
They then join the remaining part of the stomach and bile duct to the small intestine. The pancreas is joined to the small intestine or to the stomach.
This diagram shows the parts of the body to be removed by a Whipple’s operation
This diagram shows the pancreas and surrounding organs after a Whipple’s operation
As part of your pancreas is removed during a Whipple’s operation, your digestion will be affected. You will need pancreatic enzyme supplements to help you digest food. There is also a chance that you might get diabetes – this can happen at any time after your operation.
This operation is similar to the Whipple’s operation for pancreatic cancer, but none of the stomach is removed. The stomach valve (the pylorus), which controls the flow of food into the duodenum, isn’t removed either. The tail of the pancreas is joined to the small intestine or stomach.
A distal pancreatectomy removes the body and tail of the pancreas.
The spleen is also often removed. The spleen helps your body fight infections, so if it’s removed, you will be more likely to get infections. You will usually have vaccinations before and after surgery to help prevent some infections. You will also need to take antibiotics for the rest of your life to protect you against other infections. Ask your surgical team about what vaccinations you need now and in the future.
As part of your pancreas is removed, your digestion may also be affected. You may need pancreatic enzyme supplements to help you to digest food, but this is less likely than with the Whipple’s or PPPD operations.
You will also be more likely to get diabetes and may need to take medicine to manage this. This can include insulin.
This diagram shows the parts of the body to be removed by a distal pancreatectomy
This diagram shows the pancreas and areas around it after a distal pancreatectomy
A total pancreatectomy removes the whole pancreas, the duodenum, the gall bladder, part of the bile duct and sometimes part of the stomach and the spleen. Exactly what is removed will depend on where the cancer is.
You may have a total pancreatectomy if there is a large tumour, more than one tumour, or if the remaining pancreas isn’t healthy.
This diagram shows the parts of the body that will be removed by a total pancreatectomy
This diagram shows the pancreas and areas around it after a total pancreatectomy
Sometimes pancreatic cancer grows into or around the major veins next to the pancreas – the superior mesenteric and portal veins. To remove the cancer completely, the surgeon may need to remove part of the vein. The vein is then joined back together. This is called vein resection and reconstruction. It is sometimes done by putting in a piece of vein from somewhere else in the body or using an artificial material – this is called a graft.
Vein resection makes the surgery more complicated. You need to be very fit and well to have this type of surgery.
This is specialist surgery and might not be available at your nearest specialist centre. So you may be referred to another specialist centre to have the surgery. You can also ask for a second opinion from another surgeon who is experienced in doing vein resections.
Published April 2019
Review date March 2021