Surgical Procedures for Pancreatic Cancer
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Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
Two basic categories of surgery may be used to treat pancreatic cancer: palliative and curative.
Palliative surgery does not hope to cure the cancer, but is done in an effort to relieve some of the complications of ]]>pancreatic cancer]]> and improve quality of life. Common palliative surgeries involve decompressing a blocked common bile duct, either by creating a new opening between the gall bladder and part of the intestine (cholecystojejunostomy or choledochojejunostomy) or by placing a stent into the common bile duct in order to keep it open. These procedures help relieve some of the pain associated with an obstruction.
Curative surgery aims to remove as much tumor as possible, in the hopes of actually curing the cancer. Prior to any attempts at curative surgery, it is important that detailed imaging studies are performed. Curative surgeries should only be done if the studies show that the cancer is contained within the pancreas and is, therefore, considered resectable (capable of being removed).
Potentially curative surgeries include the following:
- ]]>Distal pancreatectomy]]>
- ]]>Total pancreatectomy]]>
- ]]>Pancreaticoduodenectomy (Whipple procedure)]]>
Psychotherapy and Surgery
A study found that psychotherapy may have an important role to play in the care of patients admitted to the hospital for pancreatic cancer surgery. Ten years after surgery, patients who received psychological support were significantly more likely to be alive than those who did not receive it.]]>*¹]]>
The surgery for a distal pancreatectomy and a total pancreatectomy are very similar. The major difference is the amount of tissues and organs that are removed. In distal pancreatectomy, only the tail of the pancreas is removed. This surgery requires careful imaging studies since patients only undergo this procedure if the tumor is in the pancreatic tail.
In a total pancreatectomy, the entire pancreas (head, body, and tail) and the spleen are removed.
Description of the Procedure
You’ll be given a general anesthetic for this operation. An incision is made in your abdomen, and the appropriate portions of the pancreas and, in some cases, the spleen are carefully removed. Because the pancreas makes digestive juices, this operation must be performed with great care so that pancreatic juices don’t leak into your abdomen, where they can destroy tissue.
Surgery on the pancreas has a high complication rate, and patients often need a reasonably long hospitalization to ensure a good recovery. A one- to two-week hospital stay is typical. If there are serious complications, the hospital stay will be longer.
Pancreatic cancer is a very difficult disease to treat. Even with potentially curative surgeries, the five-year survival rate is low; about 20% of people with resected (removed) tumors are alive five years after diagnosis.
Distal pancreatectomy has a very high complication rate—about 41% or more of all patients experience some type of complication. In order of importance, the potential complications after pancreatectomy include:
- Bleeding—This can be massive, requiring a return trip to the operating room to locate the source of bleeding and stop it.
- Delayed stomach emptying—About 19% of patients who have had pancreatectomy will experience this complication. This involves liquids and solids remaining in the stomach for an abnormally long period of time after eating or drinking. Patients with this complication may need to be fed using alternative methods (such as through a tube directly into their intestines) until their stomach heals.
- Pancreatic anastomotic leak—This complication occurs when pancreatic juices leak into the abdomen. Most surgeons try to avoid this complication by leaving drains in place; any fluids that accumulate around the area where the pancreas was removed are drained out of the abdomen through tubes.
Other possible complications include the following:
- You’ll wake up with a catheter in your bladder; if there are no complications, this will be removed within a few days.
- You’re likely to wake up with a nasogastric tube. This is a tube that enters through your nose and reaches into your stomach to drain accumulating digestive juices.
- You may also have several surgical drains, which are tubes that drain fluids out of your abdomen.
- Until your intestine begins functioning again, you’ll be given nutrition through a tube directly into your intestine, or through your veins. When nutrition is delivered directly into your veins, it is called total parenteral nutrition (TPN).
- Because you no longer have all of your pancreas, you may become diabetic after surgery. This means that you’ll need to check your blood sugar several times a day, and you will probably need to take insulin.
- You may need to take enzyme pills to help you digest your food.
- You may require antibiotics.
- You may be given medications to prevent blood clots (blood thinners).
- You’ll require regular pain medications.
Pancreaticoduodenectomy (Whipple procedure)
This operation is an attempt at curing pancreatic cancer. Before having this surgery, it is important that detailed imaging studies be done to determine that your cancer is indeed considered resectable (capable of being surgically removed).
This is an extremely extensive operation that involves removing the head and body of the pancreas, either all of the stomach or the lower part of the stomach, the first and second sections of the small intestine (duodenum and jejunum), surrounding lymph nodes, the gallbladder, and common bile duct.
This complex surgery requires great expertise on the part of the surgeon. There is a very high complication and death rate from this surgery. If you need this operation, go to a medical center where many pancreaticoduodenectomies are performed. In these settings, the death rate due to this surgery is about 2%-5%; at smaller, less experienced hospitals, the death rate may be as high as 10%.
Description of the Procedure
If you are very weak prior to surgery, you may be given liquid nutrition through a tube directly into your small intestine to help build your strength and improve your chances of a good recovery. This may be done for a week or so prior to surgery.
You’ll be given a general anesthetic for the operation. In order to access the many organs, a large abdominal incision will be made. Your surgeon will remove the necessary organs, and then spend time reconstructing your digestive tract.
Your intestine needs time to recover and begin functioning again; you’ll have to stay in the hospital until this occurs, typically up to two weeks. If you have any complications after the procedure, your stay will be longer.
Pancreatic cancer is a very difficult disease to treat. Even with potentially curative surgeries, the five-year survival rate is low; only about 20% of people who undergo resection (removal of tumor) are alive five years after diagnosis.
Possible Complications and Postoperative Care
About half of all patients who undergo pancreaticoduodenectomy experience complications after surgery. The death rate after operation may be as high as 15%. The possible complications are the same as those for a pancreatectomy, and the post-operative care is the same, as well.
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DiMagno E. Pancreatic carcinoma. In: Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000: 750-752.
Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician. 2006;73:485-492.
Ujiki Mb, Talamonti MS. Surgical management of pancreatic cancer. Semin Radiat Oncol. 2005; 15:218-25
What you need to know about cancer of the pancreas. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/wyntk/pancreas#2 . Accessed April 8, 2009.
*¹9/18/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Küchler T, Bestmann B, Rappat S, Henne-Bruns D, Wood-Dauphinee S. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol. 2007;25:2702-2708.
Last reviewed February 2009 by ]]>Igor Puzanov, MD]]>
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