Pancreatic Surgery

What is pancreatic surgery?

There are several surgical procedures that can be used to treat pancreatic cancer. The majority of these procedures involve the removal of part or all of the pancreas and the other tissues and organs which surround it in the stomach region.

You will discuss the most suitable type of procedure with your surgeon. The type of surgery that is most suitable can depend on the location of cancer within the pancreas, and the size of the area affected.

The main types of pancreatic surgery are; the Whipple's procedure, total pancreatectomy, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy (PPPD), and removing part of a vein.


Am I a good candidate for pancreatic surgery?

The Whipple's procedure is typically suitable for tumours located in the neck or head of the pancreas, which has not spread further. PPPD is similar to the Whipple's procedure but does not remove any of the stomach, while a distal pancreatectomy removes the tail and body of the pancreas, and sometimes the spleen.

A total pancreatectomy is typically required if there are multiple tumours, a large tumour, or if the remaining part of the pancreas is unhealthy.

The partial removal of a vein can be required when pancreatic cancer has developed into the major veins next to the pancreas. This is called borderline resectable or locally advanced pancreatic cancer, depending on how severely affected the vein is.

Pancreatic cancer can also grow around major arteries to the liver, stomach and intestines. This is also called borderline or locally advanced pancreatic cancer. Surgeons do not typically remove these arteries, but chemotherapy given before surgery can help surgeons to remove cancers from these arteries.

How does pancreatic surgery work?

What pancreatic surgery involves will depend on the type of procedure. Pancreatic cancer surgery is typically carried out as open surgery or keyhole (robotic or laparoscopic) surgery, using general anaesthetic.

The Whipple's procedure involves the surgeon removing the head of the pancreas, as well as the first part of the small intestine (duodenum), part of the bile duct, gall bladder and surrounding lymph nodes. The bile duct and remaining section of the stomach are then joined to the small intensive before the pancreas is attached to the stomach or small intestine.

Unlike, the Whipple's procedure, PPPD removes the head of the pancreas but does not remove any of the stomach, or the pylorus (stomach valve). It involves the joining of the pancreas tail to the stomach or small intestine. A distal pancreatectomy involves the removal of the body and tail of the pancreas, and sometimes the spleen.

A total pancreatectomy will remove the whole pancreas, and the nature of the procedure will depend on the location of cancer. The partial removal of a vein is done to remove cancer completely when it has developed from the pancreas to the major veins next to it - specifically the portal and superior mesenteric veins. Vein resection and reconstruction can be done using a graft or a piece of vein from elsewhere in the body.

With the exception of a distal pancreatectomy, for which it is not always needed, these types of pancreatic surgery all require pancreatic enzyme replacement therapy following the procedure in order to help with the digestion of food.

Recovery from pancreatic surgery

It can take from a few months to a year to recover fully from pancreatic surgery. The prognosis after pancreatic surgery will vary according to the individual and whether cancer cells have spread elsewhere in the body. For the Whipple's procedure, the five-year survival rate is around 20 to 25 per cent (this prognosis is affected by many factors, so is a general guide; please ask your surgeon for more information).

It is essential to receive chemotherapy before or after surgery, as this greatly improves chances for survival. 

It is also essential to replace pancreatic enzymes in the diet. After pancreas surgery, particularly removal of the head or the whole pancreas, there is insufficient enzyme produced by the pancreas. If left untreated this leads to weight loss, frailty, nutrient deficiency, cramp and bloating and a reduced ability to undergo further treatment. Replacement of pancreatic enzymes is achieved by taking capsules of pancreas enzyme replacement therapy (PERT – a common brand is Creon). Your surgeon will discuss this with you.