Pancreatic Cancer Surgery

Who is eligible for surgery?

Eligibility is determined by the size and location of the primary tumor, the involvement of local lymph nodes and blood vessels and the presence of distant metastases. Although 20 percent of pancreatic cancer patients may be eligible for surgery, data shows that up to half of those patients are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.

If you are eligible for surgery, the Pancreatic Cancer Action Network strongly recommends calling PanCAN Patient Services to discuss our Know Your Tumor® precision medicine service. Know Your Tumor may help eligible patients understand what treatment will work best for future treatment decisions.

What are the different types of pancreatic surgeries?

Different types of surgery are performed depending on the location of the tumor within the pancreas:

Whipple procedure (pancreaticoduodenectomy) – The Whipple procedure is the most commonly performed surgery to remove tumors in the pancreas, and is typically performed if a tumor is in the head of the pancreas and meets other criteria for resection. In a standard procedure, the surgeon removes the head of the pancreas, the gallbladder, the duodenum, a small portion of the stomach called the antrum along with the stomach valve and surrounding lymph nodes. This surgery typically takes 5-7 hours to perform.

Distal pancreatectomy – A distal pancreatectomy is performed if a tumor is in the body or tail portion of the pancreas. In this procedure, the surgeon removes the body and tail of the pancreas, and will often remove the spleen as well.

Total pancreatectomy – A total pancreatectomy is performed when the tumor is situated in a way that requires the entire pancreas to be removed, or when there are multiple tumors spread throughout the pancreas. Because the entire pancreas is removed in a total pancreatectomy, the person will be diabetic after surgery and must use insulin to control their blood sugar levels.

When is surgery available/used?

Determining a patient’s eligibility for surgery is not always easy. Even sophisticated imaging tests may not provide a perfect picture of the tumor. In general, a pancreatic tumor is considered resectable if it has not spread beyond the pancreas and does not involve major arteries. If veins are involved, a qualified surgeon may be able to perform a vein resection.

In some cases, during surgery, the surgeon will find that the cancer has spread, and the operation will be ended. If surgery to remove the tumor is not possible, other interventions may be performed to help alleviate blockages or manage other symptoms.

Are surgeries for pancreatic cancer usually given with other treatments?

Sometimes treatment is given before surgery is performed to remove a pancreatic tumor. This treatment, called neoadjuvant therapy, generally involves chemotherapy, radiation therapy or both. The goal of neoadjuvant treatment is to reduce the size of the tumor so that it is more easily removed during surgery. If blood vessels, such as veins and arteries, are affected by the tumor, neoadjuvant therapy may improve the chances for a complete surgical removal.

Often, adjuvant therapy, or treatment that is given after the surgical removal of all or part of the pancreatic tumor, is given. After surgery, patients are at risk for recurrence, or reappearance, of the cancer. Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery. The aim of adjuvant therapy is to kill microscopic cancer cells that may still be present after surgery, thereby preventing recurrence of a tumor.

Clinical trials may be available for pancreatic cancer patients seeking adjuvant therapy. When considering participation in an adjuvant therapy clinical trial, it is important to note that usually adjuvant therapy clinical trials limit the length of time after surgery that patients can wait before participating in the trial. Typically, patients must start treatment on an adjuvant therapy clinical trial within two to three months after surgery. Therefore, patients considering participation in an adjuvant clinical trial should learn about their options either before surgery or immediately following.

Pancreatic cancer patients who participate in clinical research have better outcomes. The Pancreatic Cancer Action Network strongly recommends clinical trials at diagnosis and during every treatment decision. We maintain the most comprehensive and up-to-date database of pancreatic cancer clinical trials available in the U.S. Start your own search using our Clinical Trial Finder.

<!--The Pancreatic Cancer Action Network strongly recommends clinical trials at diagnosis and during every treatment decision. Clinical trials provide access to new, potentially better treatments and advance research. We maintain the most comprehensive and up-to-date database of pancreatic cancer clinical trials available in the U.S. -->

How can I find the best surgeon?

Pancreatic surgery is very complicated, especially the most common surgery, the Whipple procedure.  Additionally, about 30 to 50 percent of patients who are eligible for surgery are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.  Studies show that patients who undergo pancreatic surgery performed by an experienced surgeon have fewer complications and better outcomes.  When finding a surgeon, it is encouraged to ask how many pancreatic surgeries he or she performs each year. The Pancreatic Cancer Action Network’s PanCAN Patient Services Case Managers can provide patients and families with a listing of institutions and doctors who perform a high volume of pancreatic surgeries. Case Managers can also provide research articles supporting the benefits of getting pancreatic surgery at a high-volume institution.

How will I feel after undergoing pancreatic surgery?

After pancreatic surgery, it can take a patient anywhere from a few months to a year to feel relatively “normal” again.  It takes time for the digestive system to start working again, and some patients find that they must make permanent changes in their diet to ease symptoms such as diarrhea, gas and stomach pain. Contact PanCAN Patient Services for more information and resources on postoperative nutritional care, including pancreatic enzyme use.

What are palliative surgeries for pancreatic cancer?

Palliative procedures are performed to alleviate (palliate) symptoms. They do not involve the complete removal of the tumor. Palliative procedures may relieve symptoms of jaundice, pain, nausea and vomiting that are caused by blockage of the bile duct and/or duodenum. The most common palliative procedures for pancreatic cancer are biliary bypass surgery, gastric bypass surgery and biliary or duodenal stent insertion.

Biliary bypass surgery – Biliary bypass surgery reroutes the flow of bile around the tumor if the tumor is blocking the common bile duct. It may also relieve jaundice.

Gastric bypass surgery – This procedure can be performed if the tumor blocks the duodenum, allowing food to flow from the stomach past the blockage.

Stent placement – A stent is a small plastic or metal tube that helps keep the bile duct, pancreatic duct or duodenum open. Stent insertion can relieve blockages in these areas and may be used instead of performing a bypass procedure.

If I’m not eligible for surgery, what are my options?

You are your own best advocate. The Pancreatic Cancer Action Network strongly recommends that you discuss your treatment goals with your healthcare team and know all your options at every stage of your disease.

In addition to surgery, treatment options include:

• • Clinical trials
• • Molecular profiling, including our Know Your Tumor precision medicine service
• • Chemotherapy
• • Targeted therapy
• • Radiation therapy
• • Immunotherapy
• • Complementary and alternative therapies

Surgical Advances for Pancreatic Cancer Video

We’re Here to Help

If you have questions or would like additional information and resources about surgery, treatment options or pancreatic cancer specialists, contact a PanCAN Patient Services Case Manager.

<!--About 30 to 50 percent of patients who are eligible for surgery are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.

Eligibility is determined by the size and location of the primary tumor, the involvement of local lymph nodes and blood vessels and the presence of distant metastases. About 30 to 50 percent of patients who are eligible for surgery are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.

Surgery to remove a tumor offers the best chance for long term control of all types of pancreatic cancer.  If a tumor is able to be surgically removed, it is called resectable.  About 15-20% of patients with pancreatic adenocarcinoma have tumors which are considered surgically resectable.

When is surgery used?
In general, a pancreatic tumor is considered resectable if it has not spread beyond the pancreas and does not involve major arteries. If veins are involved, a qualified surgeon may be able to perform a vein resection. A vein resection typically adds an extra 60-90 minutes to the length of the surgery.

Determining a patient’s eligibility for surgery is not always easy. Even sophisticated imaging tests may not provide a perfect picture of the tumor. In some cases, during surgery, the surgeon will find that the cancer has spread and the operation will be ended. If surgery to remove the tumor is not possible, palliative procedures may be considered.

How should I choose my surgeon?
Pancreatic surgery is very complicated, especially the most common surgery, the Whipple procedure.  It is important to seek out a surgeon at a hospital that does a high volume, or large number, of these procedures.  Studies show that patients who undergo pancreatic surgery performed by an experienced surgeon have fewer complications and better outcomes.  When finding a surgeon, it is encouraged to ask how many pancreatic surgeries he or she performs each year.

The Pancreatic Cancer Action Network’s PanCAN Patient Services Case Managers can provide patients and families with a listing of institutions and doctors who perform a high volume of pancreatic surgeries. Associates can also provide research articles supporting the benefits of getting pancreatic surgery at a high-volume institution. Case Managers are available Monday – Friday, 7 a.m. to 5 p.m., Pacific Time.

What are the different types of pancreatic surgeries?
Different types of surgery are performed depending on the location of the tumor within the pancreas:

Whipple procedure (pancreaticoduodenectomy)
Distal pancreatectomy
Total pancreatectomy

How will I feel after undergoing pancreatic surgery?
After pancreatic surgery, it can take a patient anywhere from a few months to a year to feel relatively “normal” again.  It takes time for the digestive system to start working again and some patients find that they must make permanent changes in their diet to ease symptoms such as diarrhea, gas, and stomach pain.

Are surgeries for pancreatic cancer usually given with other treatments?
Sometimes treatment is given before surgery is performed to remove a pancreatic tumor. This treatment, called neoadjuvant therapy, generally involves chemotherapy, radiation therapy, or both. The goal of neoadjuvant treatment is to reduce the size of the tumor so that it is more easily removed during surgery. If blood vessels, such as veins and arteries, are affected by the tumor, neoadjuvant therapy may improve the chances for a complete surgical removal.

Often, adjuvant therapy, or treatment that is given after the surgical removal of all or part of the pancreatic tumor is given. After surgery, patients are at risk for recurrence, or reappearance, of the cancer. Recurrence can occur when a microscopic amount of the cancer spreads prior to the surgery. The aim of adjuvant therapy is to kill microscopic cancer cells that may be present when their numbers are small, thereby preventing recurrence of a tumor.

Clinical trials may be available for pancreatic cancer patients seeking adjuvant therapy. When considering participation in an adjuvant therapy clinical trial, it is important to note that usually adjuvant therapy clinical trials limit the length of time after surgery that patients can wait before participating in the trial. Typically, patients have to start treatment on an adjuvant therapy clinical trial within two to three months after surgery. Therefore, patients considering participation in an adjuvant clinical trial should learn about their options either before surgery, or immediately following.

The Pancreatic Cancer Action Network recommends that all patients consider clinical trials when exploring treatment options. Clinical trials provide access to new, potentially better treatments and advance research. We maintain a comprehensive and up-to-date database of pancreatic cancer clinical trials.

What are palliative surgeries for pancreatic cancer?
Palliative procedures are performed to alleviate (palliate) symptoms. They do not involve the complete removal of the tumor. Palliative procedures may relieve symptoms of jaundice, pain, nausea and vomiting that are caused by blockage of the bile duct and/or duodenum. The most common palliative procedures for pancreatic cancer are biliary bypass surgery, gastric bypass surgery, stent insertion and celiac plexus block.

Biliary bypass and Gastric bypass
Stent Placement
Celiac Plexus

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Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note any personal information you provide to PanCAN’s staff during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and education efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so. For more information on how we may use your information, you can find our privacy policy on our website at https://www.pancan.org/privacy/.