Johns Hopkins Medicine answered:
Surgery can be performed as a curative or palliative measure if the cancer is contained within the pancreas and has not spread to blood vessels, lymph nodes or other organs. This treatment option should be discussed with your physician to see if it is a viable option. Depending on the extent of disease and other contributing factors, surgery may be combined with chemotherapy and/or radiation. The choices for surgery include:
Surgery can be performed as a curative or palliative measure if the cancer is contained within the pancreas and has not spread to blood vessels, lymph nodes or other organs. This treatment option should be discussed with your physician to see if it... More
- Whipple Surgery – During this procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder, and associated lymph nodes. In some cases, the entire duodenum and a portion of the stomach must be removed. In these instances, surgeons reconstruct the digestive tract. Surgeons at Johns Hopkins Medicine honed the procedure, drastically reducing the mortality rate associated with the surgery. Additionally, they perform more Whipple surgeries than anywhere else in the world.
- Distal Pancreatectomy – Surgeons remove tumors of the body and the tail of pancreas and leave the head of the pancreas intact.
- Total Pancreatectomy – This procedure is the least common of all of the surgeries and is used when tumors extend throughout the pancreas. In a total pancreatectomy, surgeons remove the entire pancreas and the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach.
- Minimally-Invasive Pancreas Removal – Offered at only a select group of cancer centers like Johns Hopkins, this procedure can reduce blood loss, risk of infection and speed recovery. Eligibilty depends on the tumor’s location, size and other medical factors.
- Palliative Surgical Procedures – These operations, such as a double bypass or a celiac nerve block, are performed to improve a patient's quality of life by reducing disease symptoms and pain.
The best chance for cure with pancreatic cancer is a combination of surgery, chemotherapy and radiation. Unfortunately, not all pancreatic tumors are resectable. The deciding factors as to if a tumor can be treated surgically are tumor location, lymphatic invasion, metastasis, vascular involvement, and potential for negative margins. In order to proceed with a surgery, a pancreatic tumor must not have evidence of metastasis, encasement or direct involvement of the SMV or SMA and/or absence of fat planes with the IVC, aorta, celiac axis or hepatic artery.
The potential surgeries for tumors to the head of the pancreas include the standard or modified (pylorus preserving or ultraradical) pancreaticoduodenectomy (whipple), and pancreatectomy. The standard pancreaticoduodenectomy is a large surgery that involves the pancreatic head, the duodenum, bile duct, stomach, jejunum and gall bladder. These are reconstructed in such a way as to remove the tumor that involves the head of the pancreas while preserving some pancreatic function. The pylorus preserving pancreaticoduodenectomy involves taking less of the duodenum as well as the stomach, which can preserve the pylorus and in associated with less instances of dumping syndrome. The ultraradical pancreaticoduodenectomy involves taking the entire pancreas, portal vein reconstruction, with retroperitoneal lymphadenectomy. This has been appropriate in the setting of more advanced disease. The pancreatectomy involves removing the entire pancreas and potentially the spleen and is decided optimal when the tumor is large and negative margins are difficult to achieve, but a total pancreatectomy can leave the patient a brittle diabetic.
Tumors to the body and tail of the pancreas rarely are able to be resected due to advancement of disease upon discovery. These tumors have frequently metastasized at the time of staging. When able to be surgically resected, a pancreatectomy or distal pancreatectomy is performed. This involves removing the pancreas or removing the body or tail of the pancreas with potential splenectomy. Once again, diabetes is a serious risk factor with these surgeries, and an absolute consequence of the total pancreatectomy.The best chance for cure with pancreatic cancer is a combination of surgery, chemotherapy and radiation. Unfortunately, not all pancreatic tumors are resectable. The deciding factors as to if a tumor can be treated surgically are tumor location,... More