Who can have surgery for pancreatic cancer?

Surgery is the best treatment for people with pancreatic cancer that is contained in the pancreas. It can help people live longer. Cancer that can be removed by surgery is called resectable or operable cancer.

Only a small number of people can have surgery. This is partly because pancreatic cancer may not be diagnosed early enough for it to be possible to remove the cancer.

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

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

Your doctor will talk to you about whether surgery is an option for you. 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. Your medical team will look carefully at your test results to work out if surgery is possible.

You need to be fit and well enough to have surgery and will have tests to check this. Some hospitals offer programmes to help people get fit enough. This is called prehabilitation. It focuses on diet and physical activity to help people recover more quickly after surgery. Read more about the tests and preparing for surgery.

Surgery might not be possible for some people.

• If you have some other health problems, such as heart or lung disease, you may not be able to have surgery.
• Surgery is not usually possible if you have locally advanced cancer. This is cancer that has spread just outside the pancreas to large blood vessels (see below) or a number of lymph nodes (part of the immune system).
• If the cancer has spread to other parts of the body (advanced or metastatic cancer), you won’t be able to have surgery.

If surgery isn’t an option, you may be offered chemotherapy to help control the growth of the cancer and help with some symptoms. There are also other treatments to manage any symptoms you have.

When the cancer is close to major blood vessels

Sometimes the cancer may grow very close to large blood vessels near the pancreas. It may be possible to have surgery to remove the cancer, but it depends which blood vessels are affected and how far the cancer has grown.

This is called borderline resectable pancreatic cancer. Your doctor may not call it this, they may just focus on whether your cancer can be removed with surgery.

• If the cancer is touching an artery or vein, you may be offered chemotherapy on its own or with radiotherapy (chemoradiotherapy). If this shrinks the cancer, then surgery might be possible later on.
• Sometimes the surgeon may need to remove part of a vein.
• If the cancer has grown around the artery or vein, it’s less likely to be possible to remove the cancer, even after chemotherapy.

Pancreas with surrounding blood vessels diagram:

If it’s not possible to remove the cancer, your doctor will discuss other treatments with you. This might include chemotherapy. Chemotherapy won’t cure the cancer, but it may help you live longer and help your symptoms.

Speak to your doctor or nurse about whether surgery is an option for you, and whether you will have chemotherapy and radiotherapy.

Getting a second opinion

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 medical team don’t think it’s possible, you can ask for a second opinion from a different medical team. Be aware 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 they can’t remove the cancer. This may happen because:

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

If this happens, the surgeon may do a different operation called bypass surgery. This type of surgery won’t remove the cancer, but it can help control any symptoms. After bypass surgery you may be able to have chemotherapy to help manage the cancer.

What is bypass surgery?

During surgery the surgeon will connect the stomach or the bile duct to the small intestine. This allows food to pass from the stomach to the small intestine, or stops the bile duct getting blocked.

Bypass surgery is a major operation. Recovery can take two to three months, or sometimes longer. We have information about what happens after surgery, side effects, and going home after your operation, which may be helpful for you.

It can be upsetting to find out that it wasn’t possible to remove the cancer. We are here for you. Read about the support available.

Published November 2021

Review date November 2023