Surgery to try to cure pancreatic cancer

The type of operation you have depends on where the cancer is in the pancreas. The pancreas has 3 parts:

• head (the wide end of the pancreas)
• tail (the thin end)
• body (the middle part of the pancreas)

For cancer in the head of the pancreas 

You might have a type of surgery called:

• pylorus preserving pancreaticoduodenectomy (PPPD)
• Whipple's procedure (if the cancer has spread into the stomach)

For cancer in the body or tail of the pancreas

You might have surgery to remove the body and tail of your pancreas. It is called a distal pancreatectomy. 

Very rarely, your surgeon might plan to remove the whole pancreas. This is called a total pancreatectomy.

Surgery to remove the head of the pancreas

Pylorus preserving pancreaticoduodenectomy (PPPD)

Taking out the head of the pancreas is called pylorus preserving pancreaticoduodenectomy (PPPD).

It involves removing:

• part of your pancreas

• the first part of your small bowel (the duodenum)

• your gallbladder

• part of your bile duct

After the surgery, the tail of the pancreas is joined to a bit of your small bowel. This diagram shows how the surgeon might repair what is left behind.

Whipple's operation

This operation is the same as a PPPD but you also have part of your stomach removed. This diagram shows what your surgeon removes.

This diagram shows how the surgeon might repair what is left behind.

Because you keep part of your pancreas with these operations, you might not need to take insulin to control your blood sugar levels. You may also not need to take enzymes to help you digest food (although around 1 in 3 people who had have had a Whipple's operation do need enzymes). Your doctor will monitor your digestion and blood sugar to make sure you can manage on your own.

You will need support with your eating and drinking after these types of surgery. It might take time to return to a normal diet.

Removing the tail of the pancreas (distal pancreatectomy)

This removes the body and tail of the pancreas and leaves the head. Your surgeon also usually removes the spleen  because the tail of the pancreas is right next to it.

Distal pancreatectomy is not suitable for everyone. Many people have cancer that has spread and so it can't be completely removed. 

You have part of your pancreas left behind after the surgery. Like the other types of surgery to remove pancreatic cancer, it involves a major operation and a long anaesthetic . You might need to have medicines for diabetes, such as insulin, after this type of surgery. And you may need to take enzymes to help with digestion. 

Removing the whole pancreas (total pancreatectomy)

This surgery is not very common in the UK. 

It involves taking out:

• the whole of the pancreas
• your duodenum
• part of the stomach
• the gallbladder and part of your bile duct
• the spleen
• many of the surrounding lymph nodes

This diagram shows you what the surgeon takes away.

This diagram shows you how the surgeon repairs what is left behind.

You must be fit enough for such major surgery, this is so you can cope with the long general anaesthetic and get over the operation. 

Losing your pancreas will affect your digestive system. You will also have diabetes. Losing your spleen increases the risk of infection and can affect your blood clotting.

After the surgery you will:

• take enzymes to help you digest food
• have regular blood sugar checks and insulin injections
• have vaccinations and possibly take antibiotics for the rest of your life to prevent infections (if your spleen has been removed)

It will take some time to get back to eating normally after this type of surgery. You may have problems absorbing food and with diarrhoea.

Keyhole (laparoscopic) surgery

In some specialist centres, you may have your operation as keyhole (laparoscopic) surgery.

This type of surgery is only suitable for a small number of people. It is more commonly used for distal pancreatectomies, particularly for small pancreatic neuroendocrine tumours.

Your surgeon makes several small cuts in your tummy (abdomen) instead of one large cut, as for more traditional open surgery. These small cuts are called port holes. In each port hole your surgeon places a hollow tube.

Through one of the holes your surgeon passes a long narrow tube called a laparoscope. The laparoscope is connected to a light and fibre optic camera that shows pictures of the inside of your body on a video screen. 

Through the other holes your surgeon passes instruments they use to remove the tumour while watching what they are doing on the screen.

In a few centres, the surgeons may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery.

The surgeon sits at a control unit a few feet away from you. The surgeon controls the movement of a set of robotic surgical equipment, guided by a video camera. This gives them a 3D view, which they can magnify a number of times. This helps them carry out difficult operations using very precise movements.

The photo below is an example of robotic surgery. You can see the surgeon sitting at the control unit on the right of the picture.

Laparoscopic surgery may cause less pain and the recovery time may be quicker compared to open surgery. This is still quite a new way of doing surgery for pancreatic cancer and more research is needed.