Understanding Pancreatic Cancer: Surgery
There are 2 types of surgery used for pancreatic cancer:
- Potentially curative: used when it seems possible to remove all the cancer.
- Palliative surgery: used if tests show the tumor is too widespread to be completely removed. In this case, surgery is done to relieve symptoms or prevent problems like bile duct blockage.
If only part of the cancer can be removed, surgery may not be recommended. Removing only part of the cancer does not prolong life or cure the cancer. Pancreatic cancer surgery is a very difficult surgery and requires a long recovery period. You should talk to your doctor about whether it’s a good option for you.
Surgery to try to cure the cancer (potentially curative surgery)
If it looks like the pancreatic cancer can be completely removed from the head of the pancreas, the Whipple procedure is the most common type of surgery. In this procedure, the surgeon removes:
- Part of the pancreas
- Part of both the stomach and small intestine
- Part of the common bile duct
- Nearby lymph nodes
After these are removed, the surgeon attaches the rest of the duodenum, pancreas, and bile duct to the small intestine. This way bile and pancreatic enzymes can still enter the digestive system normally.
A Whipple surgery is very complex. It is advisable to have the surgery in a hospital that does at least 20 Whipple surgeries a year.
Total Pancreatectomy: This is a rare procedure that removes the entire pancreas and spleen. Without a pancreas, the body cannot make insulin that controls blood sugar levels. After a pancreatectomy, your body will be dependent on insulin injections.
Distal Pancreatectomy: In this procedure, the tail and body of the pancreas are removed. Part of the pancreas can be preserved. The spleen is also usually removed.
Pancreatic cancer can progress quickly. For this reason, many doctors do not operate just to relieve symptoms. Your doctor may recommend surgery in the hope of curing you. However, sometimes during this operation the surgeon discovers the cancer has spread, and a cure is not possible. If this happens, the surgeon will use the operation to relieve symptoms or prevent problems like blockage of the bile duct.
When the bile duct is blocked, it can cause pain and problems with digestion. There are 2 surgical approaches to relieving the blockage:
Bypass surgery: Re-route the flow of bile from your common bile duct into your small intestine. This operation requires a large incision (cut). Recovery time is several weeks. During this surgery, your doctor may be able to cut the nerves leading to your pancreas. This can reduce or eliminate your pain.
Stents: Metal stents can be inserted to keep the bile duct open. Your doctor will use a thin, flexible tube called an endoscope to put in the stent. Recently, the use of stents is more common than bypass surgery in relieving bile duct blockage.
Other types of surgery (ablative techniques)
Other types of surgery, called ablative techniques, may be used to treat areas of spread (metastases) from pancreatic cancer, usually to the liver. This is an option when only a few metastases are present. By treating the metastases, symptoms can improve and the patient may live longer.
Radiofrequency ablation (RFA): This procedure uses radio waves to heat and destroy cancerous tissues.
Microwave thermotherapy: This procedure uses microwaves to heat and destroy the cancer.
Cryosurgery (also called cryoablation): In this procedure, a probe is put directly into the tumor. Then liquid nitrogen or liquid carbon dioxide is injected to freeze the tissue. The frozen area is destroyed.
Embolization: In this procedure, a catheter is used to find the blood vessel feeding the tumor. Then tiny beads called microspheres are put into the blood vessel. Sometimes these beads are radioactive. Injecting these beads cuts off the blood supply and kills the tumor. The catheter can also be used to deliver chemo drugs. This process is called chemoembolization.