Pancreatic Cancer Surgery

Pancreatic Cancer Surgery

Distal Pancreatectomy

In an open procedure, your surgeon removes the benign or malignant tumors in the body or tail of the pancreas; your spleen is removed as well (it is located near the pancreas and shares some of the blood vessels).

Laparoscopic Distal Pancreatectomy

This is similar to a distal pancreatectomy, but is a minimally invasive procedure. It is performed laparoscopically, meaning the procedure is performed using smaller incisions.

Complications are minimal, but may include:

  • Diabetes: This may occur if you have a family history of diabetes or you are pre-diabetic. The pancreas is responsible for releasing insulin, which controls blood sugar. So, the removal of part of your pancreas affects your blood sugar level.
  • Pancreatic enzyme insufficiency: If this occurs, you may require pancreatic enzyme replacement therapy.
  • Weakened immune system: Vaccines are recommended if you underwent a splenectomy, because the spleen plays an important role in the immune system. You will need extra vaccines to help fight infections.

Pancreaticoduodenectomy (Whipple procedure) and Laparoscopic-Assisted Whipple

This is the most common operation performed to treat pancreatic masses and offers the best chance for long term control of disease. The procedure is used to treat benign masses or cancers in the head of the pancreas, ampulla of Vater, duodenum, common bile duct, and sometimes to treat chronic pancreatitis. The laparoscopic assisted Whipple is a minimally invasive, complex procedure that requires the skill of highly trained, specialized surgeons to ensure the best outcomes.

Two types of Whipple procedures are performed; your surgeon will discuss with you which procedure is best for you:

  • The modified or pylorus-preserving (most common) does not remove any part of the stomach.
  • The standard Whipple procedure removes the head of the pancreas, the gall bladder, common bile duct, duodenum (the first portion of the small intestine), a small portion of the jejunum (the second portion of the intestine), the pyloric antrum and pylorus (the bottom third of the stomach), and the lymph nodes near the head of the pancreas.

Your surgeon then reconnects the small intestine to the bile duct, remaining pancreas, and stomach.

Total Pancreatectomy

A total pancreatectomy is uncommon, only being performed when the disease involves the entire pancreas and no other surgical options are available. The operation involves the removal of entire pancreas, the gall bladder, common bile duct, duodenum (the first portion of the small intestine), a small portion of the jejunum (the second portion of the intestine), the pyloric antrum and pylorus (the bottom third of the stomach), lymph nodes near the pancreas and the spleen. The procedure requires the skill of highly trained, specialized surgeons to ensure the best outcomes.

In addition to the typical risks and complications associated with abdominal surgery, some specific to a total pancreatectomy include:

  • Diabetes: The pancreas is responsible for producing insulin, a hormone which regulates the body's blood sugar level. Because your body will no longer have the ability to produce insulin, you will be required to take insulin by injection and follow a diabetic diet for the remainder of your life.
  • Pancreatic enzyme insufficiency: If this occurs, you may require pancreatic enzyme replacement therapy to help aid digestion.
  • Weakened immune system: Vaccines are recommended for all patients who undergo a splenectomy. The spleen plays an important role with the immune system, and when it is removed, you will become more susceptible to certain infections. You may receive vaccines such as pneumovax and H.flu to help fight infections.
  • Delayed gastric emptying: After surgery, your stomach may take much longer than usual to empty. This condition often resolves itself in 7-10 days as the stomach begins to heal and resume its normal functions. If it does not, your surgeon will discuss the best way to treat this situation.
  • Blood loss: Most patients do not require a blood transfusion, but some may if surgery and blood loss is extensive.

Before you leave the hospital after any surgical procedure, you will receive detailed discharge instructions that cover the following:

  • Diet
  • Medication
  • Pain
  • Constipation
  • Incision care
  • Activity after surgery
  • Follow-up appointments
  • Help at home
  • Recovery time

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