Who can have surgery?

You may be able to have surgery to remove pancreatic cancer if:

• there are no signs that the cancer has spread beyond the pancreas
• you are fit enough to have the operation.

Cancer that can be removed is called resectable or operable pancreatic cancer.

Surgery might not be possible if:

• the tumour has grown too large and spread outside the pancreas to nearby large blood vessels
• the cancer has spread to other parts of the body such as the liver or lungs (advanced or metastatic cancer).

Instead you may be offered other treatments to help control the growth of the cancer and any symptoms.

As well as other scans you have already had, you may have an FDG-PET/CT scan to help check if it is possible to remove the cancer. FDG-PET/CT stands for fluorodeoxyglucose-positron emission tomography / computerised tomography. Read more about scans.

You need to be fit and well enough to have surgery and will have tests to check this. If you have any health problems, such as heart disease, you may not be able to have surgery. Some hospitals offer programmes to help people get fit enough for surgery. This is called prehabilitation. It focuses on diet and physical activity to help reduce the time it takes to recover after surgery.

When the cancer is close to major blood vessels

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

• If the cancer is touching an artery or vein, you may be offered chemotherapy first (see below). If this shrinks the cancer, then surgery might be possible later on.
• The chemotherapy may be offered as part of a clinical trial. Sometimes radiotherapy together with chemotherapy may be offered after the first chemotherapy.
• Sometimes the surgeon may need to remove part of a vein.
• If the cancer has grown around the artery or vein, it’s not usually possible to remove the cancer with surgery, even after chemotherapy.

A diagram of the pancreas and surrounding blood vessels

If it’s not possible to remove the cancer, your doctor will discuss other treatments with you. This might include chemotherapy.

Your medical team will look carefully at your test results to work out if surgery is possible. But it can be difficult to tell how close the cancer has grown to blood vessels and whether it is possible to remove it. This means that different medical teams may have different opinions about whether surgery is possible. If your doctors don’t think it’s possible to remove the cancer you can ask for a second opinion from a different medical team. Be aware though that the second team’s opinion may not be any different.

When it’s not possible to remove the cancer?

Sometimes the surgeon may start the operation, but find that it’s not possible to remove the cancer. This may happen because:

• the cancer has spread to your liver
• the cancer has spread to the lining of your abdomen (tummy area)
• the cancer has grown into or around the blood vessels near the pancreas in a way that means it can’t be removed.

If this happens, your operation won’t continue as originally planned. Instead the surgeon may do a different operation, called bypass surgery, to help control symptoms. You may also be offered chemotherapy to help control the cancer.

It can be upsetting to find out that it wasn’t possible to remove the cancer. Read more about support to help you cope with pancreatic cancer.

Chemotherapy before or after surgery

Before surgery

Chemotherapy may sometimes be given before surgery to try to shrink the cancer, so that the surgeon has a better chance of removing it.

Some people with borderline resectable pancreatic cancer may be offered chemotherapy, then sometimes radiotherapy together with chemotherapy – this is called chemoradiotherapy. The aim is to try to shrink the cancer and make surgery possible. The chemotherapy drug most often used for chemoradiotherapy is capecitabine.

Chemotherapy before surgery may be given as part of a clinical trial. These clinical trials are medical research studies looking at the best ways to use chemotherapy with surgery.

After surgery

You should be offered chemotherapy after surgery to try to reduce the chances of the cancer coming back.

• The chemotherapy drugs most often used after surgery are gemcitabine with capecitabine (GemCap).
• Another chemotherapy treatment called FOLFIRINOX may be offered instead of GemCap to people who are well enough to deal with it.
• If you aren’t well enough to cope with GemCap, you may be offered gemcitabine alone, as it may have fewer side effects.

You should be given time to recover properly from the surgery before starting chemotherapy, as you need to be well enough to cope with six rounds (cycles) of treatment. This could be up to 12 weeks after your surgery.

If you are having any eating problems after your surgery, speak to your doctor, nurse or dietitian to make sure these don’t delay the chemotherapy.

Published April 2019

Review date March 2021