Pancreatic Cancer Surgery: Everything You Need to Know

Pancreatic cancer surgery is a major procedure that can alleviate the effects of pancreatic cancer to improve survival. Sometimes pancreatic cancer can be cured, but often the treatment relieves some aspects of the disease even if a complete cure isn't possible. Management of pancreatic cancer includes surgery, radiation, chemotherapy, and immunotherapy.

What Is Pancreatic Cancer Surgery?

Pancreatic cancer surgery includes surgical operations that remove the tumor from the pancreas and surrounding areas. Your procedure can also include clearing blockages in the ducts or other structures around the pancreas.

The pancreas lies just behind the stomach and the duodenum (the entrance of the small intestine). It produces digestive enzymes, so removing it can have a substantial effect on your nutrition. Pancreatic cancer surgery usually involves the removal of some, but not all, of the pancreas whenever possible.

You would have your procedure under general anesthesia. You might have an open procedure or a minimally invasive laparoscopic surgery, depending on the size of the tumor and how widespread your cancer is.

Often, complicated surgeries with multiple areas of cancer or a high risk of bleeding are done with an open procedure. When surgery is done for removal of a small cancer growth without duct blockage or involvement of blood vessels, a laparoscopic operation might be done.

Types of pancreatic cancer surgery include:

• Whipple procedure: Also described as pancreaticoduodenectomy, this is the surgical removal of the gallbladder, common bile duct, the head of the pancreas, part of the duodenum, part of the stomach, the spleen, and nearby lymph nodes. The pancreas tail and part of the pancreas body are left to preserve the production of digestive enzymes and hormones.
• Whipple procedure variations: There are several modifications to the classic Whipple procedure. These surgeries may preserve more digestive function and help minimize postoperative complications. Variations such as pylorus-preserving pancreaticoduodenectomy involve the removal of less of the stomach and/or duodenum.
• Distal pancreatectomy: Cancers in the body or tail of the pancreas are seldom operable, but when they are, the tail of the pancreas may be removed with or without the spleen.
• Total Pancreatectomy: Total pancreatectomy is essentially the same as a Whipple procedure, but differs in that the entire pancreas is removed.

Generally, your surgeon would plan the type of procedure that you are having in advance. But sometimes pancreatic surgery is more widespread than anticipated, and the procedure may change from laparoscopic surgery to an open procedure, or your surgeon might remove more of the pancreas or the intestine than initially planned.

Contraindications

Surgery is not always an option if you have pancreatic cancer. Sometimes the cancer is so far advanced that surgery would be expected to reduce life expectancy and diminish quality of life.

And the tumor location can make it inoperable. For example, if your pancreatic cancer has enveloped major blood vessels, the risk of life-threatening bleeding during surgery could mean that you are not a candidate for surgery.

Additionally, very serious health problems, like end-stage liver or heart failure, can make you unlikely to recover after pancreatic cancer surgery and might make an operation too risky for you.

Potential Risks

If you have pancreatic cancer surgery, you will be exposed to the risks of general anesthesia and surgery.

Additional complications that can occur with pancreatic cancer surgery include:

• Life-threatening bleeding
• Infection
• Blood clots
• Gastrointestinal inflammation
• Gastrointestinal blockage
• Digestive problems leading to malnutrition
• Dumping syndrome, with severe weight loss due to diarrhea shortly after eating
• A severe decline in overall health with a reduced quality of life

After a total pancreatectomy, the body doesn't produce insulin, glucagon, or digestive enzymes. Diabetes develops and insulin therapy and enzyme replacement are necessary.

Purpose of Pancreatic Cancer Surgery

Pancreatic cancer is fatal if it is untreated. The condition doesn't resolve or improve on its own, and it worsens rapidly. So a treatment plan needs to be considered immediately after diagnosis, or even sooner, such as during the diagnostic process.

Pancreatic cancer can spread locally, obstructing the small intestine, pancreatic and bile ducts, or interfering with blood flow. These issues may cause symptoms and can lead to death.

Treatment is rarely curative, although it can help slow the growth of the tumor, reduce the symptoms, and improve your quality of life. Relieving obstruction due to pancreatic cancer can be highly beneficial even if the cancer isn't cured.

Pancreatic cancer surgery is the only treatment option that can potentially cure the disease. Surgery can also be considered as an option for palliative care to reduce the symptoms of the condition.

In the early stages, pancreatic cancer doesn't typically cause noticeable signs or symptoms. It is usually diagnosed at a late stage when it has already spread within the abdomen or after it has metastasized to distant areas of the body.

The late-stage effects of pancreatic cancer include:

• Fatigue
• Jaundice (yellow discoloration of the skin and eyes)
• Weight loss
• Abdominal pain and discomfort
• Dark urine
• Pale stools
• Itching skin
• Abdominal distension (widening) and/or lumps that are felt in the abdomen

Sometimes blood tests may identify high blood sugar or elevated bilirubin, but the condition is generally diagnosed with abdominal imaging tests. If pancreatic cancer is detected incidentally, such as when you have an imaging test for another reason, it is important that you discuss a treatment plan with your healthcare provider promptly.

How to Prepare

You will need to have an oncologist and a surgeon involved in your pancreatic cancer surgery preparation.

You might have a laparoscopic biopsy before surgery so your tumor can be examined under a microscope for grading and staging. You are likely to have abdominal and chest imaging tests to identify metastatic lesions.

Chemotherapy and radiation therapy are usually part of the treatment for pancreatic cancer.

You might have neoadjuvant chemotherapy, which is a chemotherapy regimen that is given to shrink the tumor before surgery. Similarly, you might have radiation to shrink your tumor before your operation.

Pre-operative testing includes a chest X-ray and electrocardiogram (EKG) and blood tests, such as a complete blood count (CBC), blood chemistry tests, and liver function tests. If your pre-operative diagnostic testing reveals surgical contraindications, your surgery would have to be canceled.

Location

Your operation will be done in a hospital operating room. Often, pancreatic cancer surgery is done while you are already in the hospital, but you might come in from home for your surgery appointment.

You will need to stay in the hospital for at least a few days after your surgery, and possibly for several weeks after your operation.

What to Wear

You can wear anything comfortable when you go to your surgery appointment. You will change into a hospital gown for your surgery and you will also wear a hospital gown while you are staying overnight as an inpatient.

Food and Drink

You will have to fast from food and drink after midnight the night before your surgery.

Medications

You will have very specific instructions regarding medication use prior to your surgery. If you have been taking medications such as blood thinners or treatment for diabetes or hypertension prior to your pancreatic cancer diagnosis, the doses may be adjusted for a few days before your surgery.

You might have a few new medications started before your surgery. Chemotherapy could be part of your pre-surgical treatment. And other medications to help manage the symptoms of your pancreatic cancer may include pain medication or insulin. You could still be adjusting to these treatments at the time of your surgery.

What to Bring

When you go to the hospital for your surgery, you need to bring your identification, health insurance information, and a method of payment if you will be paying for a portion of your surgery.

You should have someone who can drive you home when you are discharged from the hospital after your pancreatic cancer surgery.

Pre-Op Lifestyle Changes

You might need to make some dietary adjustments due to your pancreatic cancer. This can include reducing fat intake or managing and timing your carbohydrate intake with insulin doses.

Smoking can interfere with your recovery, and your healthcare provider may suggest that you quit smoking. Keep in mind that you might not have a long wait between your pancreatic cancer diagnosis and your pancreatic cancer surgery, so you might begin smoking cessation before surgery, and you would have to maintain that after your surgery.

What to Expect on the Day of Surgery

If you are coming in from home for your pancreatic cancer surgery, you will have to register and sign a consent form. If you are already an inpatient in the hospital, you will also have to sign a consent form shortly before your operation.

You will have your temperature, blood pressure, pulse, and breathing rate monitored. You will also have your oxygen saturation monitored with a non-invasive pulse oximeter.

You will have blood tests, including CBC, chemistry panel, and liver function tests. You will also have a urinalysis. And you might have same-day imaging tests to identify any changes in your pancreatic cancer, such as a more extensive spread.

If you have not already had an intravenous (IV, in a vein) line in your arm or hand, it will be placed. You may have a urinary catheter placed before you go to the operating room or after you get there.

Your surgeon and anesthesiologist will likely check on you before you go to the operating room.

Before the Surgery

You will have your anesthesia started, and your skin cleansed in preparation for surgery. If you have not had a urinary catheter placed, it will be placed when your surgical preparation is in progress.

Your body will be covered with a surgical drape. The area where the incision will be placed will be exposed and cleaned with a surgical cleaning solution.

Your blood pressure, pulse, oxygen saturation, and breathing rate will be continuously monitored. Your anesthesia will be started as medication is injected in your IV to make you sleep. The medication will also prevent you from feeling pain and will paralyze your muscles.

You will have a breathing tube inserted in your throat so that you will have mechanical assistance for breathing throughout your surgery.

During the Surgery

Your surgeon will begin your surgery by making an incision in your skin. You may have a small incision less than an inch in length for a laparoscopic procedure, or a larger incision if you are having an open laparotomy. Your incision for an open laparotomy will be several inches long, and may vary in size. It could be longer if your surgery will involve your stomach and small intestine.

Your surgeon will then make a deeper incision into your peritoneum, which is the connective tissue that supports and encloses your abdominal organs.

If you are having laparoscopic surgery, the thin laparoscope will be inserted into your abdomen and your surgeon will use a camera to view the internal structures of your abdominal cavity.

Your surgeon will carefully cut out areas of cancer that can be safely removed. This can mean cutting away a portion of the pancreas, gallbladder, spleen, lymph nodes, and/or small intestine and stomach.

• Often, the blood vessels that had been supplying blood to the resected structures need to be closed off with sutures to prevent bleeding.
• Extensive restructuring can be a major part of this surgery. You may need to have your stomach and small intestine reattached after portions are removed from one or both.
• The ducts that connect the pancreas to the stomach and small intestine may need to be reattached after the organs are cut and restructured.
• If it is not possible for your stomach and small intestine to be immediately reattached due to severe inflammation, you may have an ostomy, which is a pouch that collects fluid. A portion of your intestine would be attached to a bag that extends outside of your skin. Your digestive structures may be reattached at a later date, possibly months after your surgery.
• If substantial post-operative swelling and inflammation are anticipated, you may have a surgical drain placed in your abdomen. This drain would extend outside your skin, and it would be removed several weeks after your surgery.

Your surgeon may also cut away portions of blood vessels or ducts that are invaded by cancer or obstructed by cancer, inflammation, or blood clots. Sometimes a stent (a small artificial tube-shaped structure) is placed permanently inside the ends of a duct as a bypass keep it open after a section has been cut away.

When the cancer is removed, the structures repaired, and the imaging tests have shown that no further repair is necessary, the surgical instruments will be removed. Your peritoneal cavity will be closed, your skin closed, and your wound covered with surgical dressing.

Your anesthesia will be reversed and the breathing tube will be removed. Your anesthesia team will ensure that you are breathing comfortably before you go to the recovery area.

After the Surgery

You will be monitored in the recovery area before you will go to your hospital room. You might spend a few days in the intensive care unit (ICU) before you go to a regular hospital room.

You will get pain medications as needed and your medical team will check on your surgical drain. If you aren't having any major complications (like extensive bleeding), you will go to your hospital room.

Over the next few days, you should be able to start drinking clear fluids and to advance your diet slowly. You will have your urinary catheter removed and you should be able to use the toilet.

Your medical care team will check on your surgical wound, as well as your ostomy and drain. And you continue to will receive pain medication as needed.

You may have imaging tests to evaluate the repair. And you might have radiation and or/chemotherapy for treatment of your pancreatic cancer.

Before you go home, you will have instructions about how to take care of your wound, drain, and ostomy. You will receive prescriptions for pain medication and any other medications that you need. And you will receive instructions about advancing your diet, complications to look out for, and follow up appointments.

Recovery

As you are recovering from your pancreatic cancer surgery, your cancer care will also be a major aspect of your overall care. You need to heal from surgery and adapt to any gastrointestinal changes resulting from the surgery.

When you go to see your healthcare provider, you will have your external sutures removed. You may have your drain removed at another visit. And you will continue to have periodic imaging tests to assess your pancreatic cancer as you are undergoing radiation therapy and chemotherapy.

Healing

In the first week home after your surgery, you may still have some abdominal tenderness and pain. You can take pain medication as prescribed, but if your pain worsens, it is important that you call your healthcare provider.

Moderate physical activity is recommended, but you should avoid activities like running or strenuous exercise while your wound is healing. Be sure to get up and walk around every day according to your instructions. Staying in bed after surgery can lead to complications, like urinary tract infections, bedsores, pneumonia, and blood clots.

Keep your wound clean and dry, and avoid placing pressure on your incision, your drain, or your ostomy.

You might be able to use an ice pack to relieve swelling—but check with your healthcare provider first because an ice pack may be problematic if you have a drain or an ostomy.

Signs of complications to look out for include:

• Fever
• Pus or blood seeping from the wound
• Warmth, redness, or severe swelling in the area of the wound
• Severe pain
• Vomiting
• Bloody diarrhea
• Dizziness, lightheadedness, feeling like you will pass out

If you experience any of these issues, be sure to call your healthcare provider's office.

Coping With Recovery

As you are recovering, you can advance your diet as instructed. Resection of the gallbladder and portions of the pancreas, stomach, and/or duodenum results in difficulty digesting food and malnutrition.

If you have an ostomy, the necessary adjustments in ostomy care and diet can be substantial.

Dietary modification may involve taking nutritional supplements and major changes to your diet. You will likely have advice from a dietitian as you are recovering from your surgery.

Long Term Care

With pancreatic cancer, you will need continued care. Radiation may be complete before surgery, or you might have radiation for the short term after surgery. Chemotherapy is a treatment that destroys cancer cells, while immunotherapy is a type of cancer treatment that uses the body's own immune system to target cancer cells.

When chemotherapy and immunotherapy are used after pancreatic cancer surgery, they are thought to improve survival by months, and rarely more than a year. Often, chemotherapy or immunotherapy for pancreatic cancer are given with the hopes that it will extend life, but not cure cancer.

The side effects of chemotherapy can include hair loss, nausea and vomiting, diminished immune function, anemia, and more.

Possible Future Surgeries

It is possible that you could need another surgery after recovering from pancreatic cancer surgery. If you have an ostomy, the intestine and stomach may be surgically reconnected after inflammation has gone down.

Metastasis to distant parts of the body, such as the lungs or bone, may need to be surgically removed, especially if they are causing symptoms like shortness of breath.

And new abdominal lesions can emerge, potentially causing effects that can be relieved with surgery.

Lifestyle Adjustments

Aside from dietary modification, the biggest lifestyle adjustments that you have to make after having pancreatic cancer surgery are associated with pancreatic cancer.

When you are being treated for cancer, you can have a better outcome if you quit smoking, maintain a healthy weight, and stay physically active.

Additionally, palliative care is an approach in which symptoms and comfort are addressed. This can be a bigger priority if your pancreatic cancer advances, especially if you have a short life expectancy.

Palliative care includes pain control, management of digestive issues, nutritional support, and emotional support. Stress, anxiety, and depression can become major concerns during this time. Counseling and/or prescription medication can help alleviate these issues.

Palliative care can also be helpful in addressing spiritual concerns, caregiver needs and communication, and practical issues ranging from insurance to financial and legal support.

A Word From Verywell

Pancreatic cancer surgery is generally a complicated operation. The recovery involves major dietary adjustments. Surgery is only a part of your pancreatic cancer care. Because this is a highly aggressive type of cancer, you will have surgery shortly after diagnosis and you may start cancer treatments before your surgery. If palliative care becomes part of your treatment plan, your loved ones will also be getting practical and emotional support throughout the process.