Types of surgery for pancreatic cancer

There are different types of surgery for pancreatic cancer. The names of these different types include:

• distal pancreatectomy
• pylorus preserving pancreaticduodenectomy (PPPD)
• Kausch Whipple operation
• total pancreatectomy
• removing parts of the veins or arteries near the pancreas (vein or artery resection)

You might have other types of surgery to relieve the symptoms of pancreatic cancer.

How does your doctor decide if you can have surgery?

To find out if it might be possible to remove the cancer, your surgeon will look at:

• the size of the tumour
• where it is in the pancreas
• whether the cancer has grown into the tissues around the pancreas
• whether the cancer is in any of the lymph nodes around the pancreas
• whether the cancer has grown into the major blood vessels in or around the pancreas
• whether the cancer has spread to any other parts of the body
• your general health and level of fitness

Using scans

Your scans show the size and position of the tumour. Smaller cancers are more likely to be removable.

Surgeons are more likely to be able to remove cancers in the head of the pancreas than in the body or tail of the pancreas. This is because they tend to be diagnosed at an earlier stage.

Scans might show cancer spread to other parts of the body. In some cases, your surgeon may still advise you to have surgery even if there is a suspicion the cancer might have spread to the nearby lymph nodes or major blood vessels.

Different types of surgery

If it is possible to remove your cancer your surgeon might suggest a:

Pylorus preserving pancreaticoduodenectomy (PPPD)

A PPPD operation means removing:

• the head of your pancreas
• the duodenum - the first part of the small bowel (intestine)
• gallbladder
• part of the bile duct

Kausch Whipple operation

This is usually called a Whipple's operation. It's the same as a PPPD operation but you also have part of your stomach removed.

Distal pancreatectomy

Your surgeon removes the body and tail of your pancreas. They also usually remove your spleen as it is very close to the tail of the pancreas. And often the spleens blood vessels are involved. 

Total pancreatectomy

Your surgeon removes all your pancreas. This operation also usually involves removing some of the surrounding organs. This includes a small part of your small bowel (duodenum), part of your stomach, gallbladder, part of your bile duct, spleen and some lymph nodes.

Vein or artery resection

Some pancreatic cancers in the head of the pancreas may have grown into nearby blood vessels. Your surgeon might know this from the scans you had or they may find out during your operation.

A resection involves the surgeon removing part of the affected blood vessel and joining it back together. In some cases they may replace the resected blood vessel with part of a vein or artery from another place in the body. This is known as a graft. Or they may use artificially made veins and arteries. The procedure is called a vein or artery resection and reconstruction.

In some cases major veins or arteries such as the portal vein or abdominal aorta are involved by the cancer. In this situation you may have chemotherapy before surgery.

Surgery to relieve symptoms

You might have an operation to help relieve symptoms such as a blocked bile duct or bowel. Usually you have a small tube (stent) put in to open up the blockage.

You usually have a stent put in during an endoscopy or through the skin (percutaneous transhepatic cholangiography), guided by x-ray.

Surgery for a blocked bile duct

The opening of the bile duct is right next to the opening of the pancreatic duct. So it is not unusual for pancreatic cancer to block the bile duct by pressing on it or growing over it. This can stop bile draining from the liver, causing jaundice. The symptoms of jaundice are:

• sickness
• feeling tired and weak
• itchy skin
• uncomfortable tummy
• wind
• yellowing of the skin or whites of the eyes

A blocked bile duct can make you feel quite unwell. Your doctor might suggest an operation to help bypass the blocked bile duct. The medical name for this operation is called a choledochojejunostomy. You pronounce it ko-led-oh-ko-jeh-ju-nost-oh-me. But it is more commonly known as biliary bypass surgery.

In this operation your surgeon cuts the bile duct above the blockage and reconnects it to the small bowel.

Surgery for a blocked bowel

You might be very sick if the cancer is blocking the very top of your small bowel (duodenum). This is because the blockage stops food passing into the bowel. Your surgeon might do an operation to bypass any blockages.

The surgeon attaches the part of your small bowel that is below the duodenum directly to your stomach. This allows digested food to pass through to the bowel.