Types of surgery for pancreatic cancer

This page explains the different operations that can be used to remove pancreatic cancer, including the Whipple’s procedure.

There are different operations for pancreatic cancer. They involve removing part or all of the pancreas. The type of surgery you have will depend on where the cancer is in the pancreas and how much of the pancreas is affected. The surgeon may also need to remove other organs and tissues around the pancreas.

The types of surgery are called:

Your surgeon will explain which operation is suitable and what will happen. Ask them if you have any questions.

Whipple’s operation (pancreatoduodenectomy or PD)

The Whipple’s procedure is the most common type of surgery for pancreatic cancer. It is used for cancers in the head or neck of the pancreas.

During a Whipple’s operation, the surgeon will remove:

  • the head of the pancreas
  • the lower end of the stomach
  • the duodenum (first part of the small intestine)
  • the gallbladder (which stores a fluid called bile, which helps digestion)
  • part of the bile duct (which carries bile from the liver to the duodenum)
  • some of the 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 like a Whipple’s, but none of the stomach is removed. This is called a pylorus-preserving pancreatoduodenectomy (PPPD).

Diagram showing the parts of the body removed by a Whipple’s operation: 

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.

 

Diagram showing the pancreas and nearby organs after a Whipple’s operation: 

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.

As part of your pancreas is removed during the Whipple’s operation, this may affect your digestion. You may need to take capsules when you eat that contain enzymes that help you digest your food. This is called pancreatic enzyme replacement therapy (PERT). You might also get diabetes after a Whipple’s procedure – this can happen at any time after your operation. Read more about side effects of a Whipple’s operation.

Distal pancreatectomy

A distal pancreatectomy removes the body (middle) and tail of the pancreas. The surgeon removes the spleen as well. This part of the operation is called a splenectomy.

Diagram showing the parts 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.

Diagram showing the pancreas and nearby organs 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.

You are more likely to get diabetes after a distal pancreatectomy. You may need medicine to manage this. Your digestion may also be affected after a distal pancreatectomy, but this is less likely than after a Whipple’s operation. If your digestion is affected, you may need to take pancreatic enzyme capsules.

The spleen helps your body fight infections, so you are more likely to get infections if it is removed. You will need vaccinations to help protect against these. You may also need to take antibiotics for the rest of your life. Ask your doctor or nurse about vaccinations and antibiotics. You can carry a card saying you have no spleen, in case you become ill.  Go to GOV.UK to get one.

Read more about possible side effects of a distal pancreatectomy.

Total pancreatectomy

You may have a total pancreatectomy if the cancer is large, or you have more than one tumour in your pancreas. The surgeon will remove:

  • the whole pancreas
  • the duodenum
  • the gallbladder
  • part of the bile duct
  • the spleen (see above).

The surgeon may also remove part of your stomach. This will depend on where the cancer is. They will then join the stomach and bile duct to the small intestine.

Diagram showing the parts 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 organs 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.

As the whole pancreas is removed in a total pancreatectomy, you will need to take pancreatic enzyme capsules to help you digest food. You will also get diabetes and will need a medicine called insulin to manage this.

Read more about possible side effects of a total pancreatectomy.

Removing part of a vein

If the cancer has grown into or around major blood vessels near the pancreas, the surgeon may need to remove part of the vein. The vein is then joined back together. This is called vein resection and reconstruction. The surgeon may put in a piece of vein from somewhere else in the body or use 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. If your surgeon is not sure if vein resection is possible, you could ask for a second opinion from another surgeon who is experienced in these.

The operation might not be available at your nearest specialist centre. You may be referred to another specialist centre to have the surgery.

Questions to ask your doctor or nurse


Which type of operation do I need?

What organs will be removed?

Will I need to take PERT or other medicines afterwards?

Speak to someone who's had surgery

We have a phone service, called Side by Side, where you can speak to a trained volunteer who has had pancreatic cancer surgery. They can share their own experience with you.

Find out more

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“Side by Side has helped me get through some very low times. I always feel so much better after the calls.”

Updated January 2024

Review date January 2026