Types of surgery for pancreatic cancer

There are different operations used to remove pancreatic cancer. They involve removing part or all of the pancreas. This page explains the different types of operation, such as the Whipple's procedure.

There are different operations for pancreatic cancer. They involve removing part or all of the pancreas. This will depend on where the cancer is in the pancreas and how much of the pancreas is affected. The surgeon may need to remove other organs and tissues around the pancreas, such as part of the stomach or duodenum (the first part of the small intestine). The types of surgery are called:

Your surgeon will discuss the best type of surgery for you and explain what will happen. Ask the surgeon any questions you have.

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Whipple’s operation (pancreatoduodenectomy or PD)

The Whipple’s procedure is the most common type of surgery for pancreatic cancer. It is used for tumours in the head or neck of 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, which helps digestion)
  • part of the bile duct (which carries bile from the liver to the duodenum)
  • nearby lymph nodes (part of the immune system).

The surgeon will 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.

You may have an operation that’s similar to the Whipple’s, but none of the stomach is removed. This is called a pylorus-preserving pancreatoduodenectomy (PPPD).

As part of your pancreas is removed, your digestion may be affected. You may need pancreatic enzyme replacement therapy (PERT) to help you digest food. There is also a chance that you might get diabetes – this can happen at any time after your operation. Read more about side effects of surgery.

This diagram shows the parts of the body removed by a Whipple’s: 

A diagram shows the parts of the body to be removed by a Whipple’s. Grey indicates the parts to be removed. The liver and bile duct are on the left, coloured in shades of pink. The bile duct connects to both the gall bladder and the duodenum. The stomach and duodenum are in the middle. The gall bladder, duodenum and lower half of the stomach are in grey. The upper part of the stomach is coloured light blue. The pancreas sits behind and underneath the stomach, with the duodenum curving around to the left of the pancreas head, which is shown in grey. The pancreas tail is dark purple.

 

This diagram shows the pancreas and surrounding organs after a Whipple’s: 

A diagram shows the parts of the body after a Whipple’s. The liver and bile duct are on the left, coloured in shades of pink. The bile duct now connects directly to the small intestines, shown in light blue, which in turn connect to the pancreas tail (dark purple). The stomach also now connects directly to the small intestines. Stitches re shown at the joins. Other organs have been removed.

Distal pancreatectomy

A distal pancreatectomy removes the body and tail of the pancreas. The spleen is also often removed – this is called a splenectomy.

This diagram shows the parts of the body to be removed by a distal pancreatectomy:

A diagram shows the parts of the body to be removed by a distal pancreatectomy. Grey indicates the parts to be removed. The liver and gall bladder are on the left, coloured in shades of pink. The stomach and duodenum are in the middle, coloured light blue. The pancreas sits behind and underneath the stomach, with the duodenum curving around to the left of the pancreas head, which is shown in dark purple. The pancreas tail, and the spleen, which is to the right, are shown in grey.

This diagram shows the pancreas after a distal pancreatectomy:

A diagram shows the parts of the body after a distal pancreatectomy. The liver, the gall bladder and the bile duct are on the left, coloured in shades of pink. The stomach and duodenum are in the middle, coloured light blue. The pancreas head sits behind and underneath the stomach, with the duodenum curving around to the left of the pancreas head, which is shown in dark purple and is shown sewn up at the end where the tail used to be. The pancreas tail and the spleen have been removed.

The spleen helps your body fight infections. If it’s removed, you may be more likely to get infections, so you will have vaccinations before or after surgery You may also need to take antibiotics for the rest of your life. You can carry a card saying you have no spleen in case you become ill. You can get these from GOV.UK.

You will be more likely to get diabetes. You may need to take medicine, such as insulin, to manage this. Your digestion may also be affected. You may need to take pancreatic enzymes, but this is less likely than with the Whipple’s operation.

Total pancreatectomy

You may have a total pancreatectomy if there is a large tumour, more than one tumour, or if your pancreas isn’t healthy.

A total pancreatectomy removes the whole pancreas and:

  • the first part of the small intestine (duodenum)
  • the gall bladder
  • part of the bile duct
  • and sometimes part of the stomach and the spleen (see above).

Exactly what is removed will depend on where the cancer is.

This diagram shows the parts of the body that will be removed by a total pancreatectomy:

A diagram shows the parts of the body to be removed by a distal pancreatectomy. Grey indicates the parts to be removed. The liver and the bile duct are on the left, coloured in shades of pink. They connect to the gall bladder, shown in grey. The stomach and duodenum are in the middle. The upper part of the stomach is coloured light blue, the lower half and the duodenum are shown in grey. The pancreas sits behind and underneath the stomach, with the duodenum curving around to the left of the pancreas head. The whole of the pancreas is shown in grey.

Diagram showing the pancreas and areas around it after a total pancreatectomy:

A diagram shows the parts of the body after a distal pancreatectomy. The liver and bile duct are on the left, coloured in shades of pink. The bile duct now connects directly to the small intestines, shown in light blue. The upper half of the stomach also now connects directly to the small intestines. Stitches re shown at the joins. Other organs have been removed.

Removing part of a vein

Sometimes the cancer grows into or around major blood vessels near the pancreas – such as the superior mesenteric and portal veins. To remove the cancer, 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, and it may take longer. You need to be very fit and well to have this type of surgery.

This type of surgery might not be available at your nearest specialist centre. 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.

Questions to ask your doctor or nurse


Which type of operation do I need?

What organs will be removed?

Will I need to take pancreatic enzymes or other medicines after my surgery?

Published November 2021

Review date November 2023