November 28, 2022

Types, Procedure, Recovery, and Outlook

5 min read

The American Cancer Society estimates that about 62,210 people in the United States will be diagnosed with pancreatic cancer in 2022.

Pancreatic cancer has a poorer outlook than many other types of cancer, but survival rates are continuing to increase as doctors learn how to best treat it. From 1975 to 2014, the 5-year relative survival rate increased from 3.2% to 11.5%.

Surgery is often used with chemotherapy and radiation therapy to try to cure pancreatic cancer. It’s also used to help manage symptoms and improve quality of life when the cancer isn’t considered curable.

In this article, we look at the most common surgical options for pancreatic cancer and when each is typically performed.

The whipple procedure for pancreatic cancerShare on Pinterest
The whipple procedure is the most common surgical option used for cancer in the head of the pancreas. Illustration by Jason Hoffman

According to the American Cancer Society, surgery offers the only reasonable chance of curing pancreatic cancer completely, and surgery is the preferred treatment option when possible.

Surgery can only be used to remove pancreatic cancer if it’s contained to the pancreas or hasn’t grown far outside. You must also be in good enough overall health to be able to withstand a major operation.

Surgical options for curing pancreatic cancer include:

Your doctor may also recommend surgery if your cancer isn’t considered curable to ease symptoms that are affecting your quality of life. Surgery is known as palliative surgery when it’s used to ease symptoms of incurable health conditions.

In about 80% of people diagnosed with pancreatic cancer, cancer has spread too far to be removed surgically.

When surgery isn’t an option, your doctor may recommend one of these procedures to ease your symptoms:

  • biliary bypass
  • endoscopic stent
  • gastric bypass

The Whipple procedure, or pancreaticoduodenectomy, is the most common procedure used to try to cure cancer in the head of your pancreas. Approximately 60 to 70% of pancreatic cancers are located here.

A standard Whipple procedure involves the removal of:

  • the upper part of your small intestines, called the duodenum
  • about 6 inches of the middle part of your small intestines
  • your common bile duct that carries bile from your liver and gallbladder through your pancreas to your small intestines
  • your gallbladder
  • the head of your pancreas
  • the distal third of your stomach (the pyloric antrum)

The majority of people also have lymph nodes removed.

A Whipple procedure is a complex operation that requires a surgeon with a lot of experience. It has a high risk of life-threatening complications such as bleeding or infection, and recovery can take up to 6 months.

According to the American Cancer Society, having the procedure done at a hospital that does at least 15 to 20 Whipple procedures per year is associated with the best outcome.

In an older 2013 review of studies, researchers found a 5-year survival rate of 11.86% in 195 people who received Whipple procedures from 1993 to 2011.

A distal pancreatectomy is a procedure to remove cancer from the tail of your pancreas with the goal of curing pancreatic cancer. Usually, your spleen is removed as well. Your spleen helps your body fight against infections, so you may be at risk of certain bacterial infections after surgery.

A distal pancreatectomy is less extensive than a Whipple procedure, but many tumors have already spread too far to be removed by the time they’re discovered. In a 2017 study, researchers found that 31.3% of a group of 48 people with pancreatic ductal adenocarcinoma who received a distal pancreatectomy lived longer than 5 years.

In a 2020 study, researchers found that the odds of developing complications were 13.2%, and the odds of developing major complications were 3.4%. Pancreatic fistula was the most common complication. A fistula is an abnormal connection between two organs.

You likely won’t be able to eat solid food for a couple of days after your procedure.

Total pancreatectomy involves the entire removal of your pancreas, gallbladder, part of your stomach, small intestines, and your spleen. Your doctor might recommend a total pancreatectomy to cure pancreatic cancer that has spread throughout your pancreas.

A total pancreatectomy is used less often than other techniques because it doesn’t seem to have a major benefit, and removing your entire pancreas can cause significant side effects. After the procedure, you’ll need to take insulin shots to regulate your blood sugar levels. Recovery generally takes roughly 1 to 3 months.

In a 2016 study, researchers found that the survival rates in 103 people undergoing total pancreatectomy were:

In the first 90 days after surgery, 32% of people developed major complications.

Your doctor may recommend palliative surgery if your cancer has spread too far to be cured. The goal of palliative surgeries is to reduce your symptoms and increase your quality of life.

Stent placement

When cancer grows in the head of your pancreas, it can block your common bile duct and cause pain or digestive problems.

A stent placement is a relatively simple procedure that involves placing a small metal tube inside of your bile duct to keep it open. This procedure is usually performed by passing a long tube called an endoscope down your throat. This tube has special tools attached that allow your surgeon to put the stent into place. Many people can recover within a few days.

In a 2020 study, researchers found 89.7% of people in a group of 14 women had improved symptoms after stent placement. Stents may need to be replaced or cleared after several months.

Bypass

Two types of bypasses may be used to relieve symptoms:

  • A biliary bypass involves cutting your gallbladder or bile duct and attaching it directly to your small intestines to treat a blockage in your bile duct.
  • A gastric bypass involves attaching your stomach farther down your small intestines when the tumor is blocking the passage of food from your stomach.

The risk of complications from bypass surgery tends to be higher than with stent placement. Recovery can take months.

According to the National Cancer Institute, five types of standard treatment are used to treat pancreatic cancer:

  • surgery
  • chemotherapy
  • radiation therapy
  • chemotherapy and radiation therapy
  • targeted therapy

Doctors also use other treatments to target specific symptoms. For example, if the tumor is pressing on nerves and causing pain that can’t be controlled with pain killers, doctors may recommend injecting pain-blocking medication or cutting nerves.

If your pancreatic cancer hasn’t spread far beyond your pancreas, your doctor may recommend surgery to try to cure your cancer. Surgery is often combined with chemotherapy or radiation therapy.

Surgery is also used as a palliative treatment when pancreatic cancer isn’t considered curable. Unfortunately, many people have cancer that has already spread too far to be removed when they’re diagnosed.

Your cancer team can help you decide what treatment is best for you. They can also advise you about any clinical trials you may be eligible for that will give you access to state-of-the-art treatments.

https://www.healthline.com/health/pancreatic-cancer/surgical-options-for-pancreatic-cancer

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