Can pancreatic cancer be treated surgically?

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.