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Some people who have early-stage| pancreatic cancer are able to have surgery to remove it, which is called a resection. Surgery can also be used to relieve symptoms if the cancer is blocking the bile duct or the bowel.
Occasionally, it’s possible to remove all of the cancer with surgery. This is a major operation. It is only suitable for people with early-stage pancreatic cancer but it may cure the cancer in some people.
This type of surgery should be done by specialist surgeons who are trained and experienced in pancreatic surgery, so you may need to be referred to a specialist centre for the operation.
It’s important to discuss the benefits and risks with your surgeon before making the decision to go ahead with any surgery.
Depending on where the cancer is, and how much of the pancreas is involved, all or part of the pancreas may be removed during surgery. One of the following operations may be done:
Your specialist may suggest that you have a laparoscopy| to see which type of surgery is possible in your case.
Occasionally, even if the cancer can’t be completely removed, the surgeon may remove some of the cancer (a partial resection) to reduce symptoms and control the cancer for a while.
Before a Whipple's operation. The colour blue shows the parts of the body that are removed during a Whipple's operation. View a large version of the diagram of the digestive system before a Whipple's operation|
After a Whipple's operation View a large version of the diagram of the digestive system after a Whipple's operation|
After your operation, you may stay in an intensive care ward for the first couple of days. You will then be moved to a general ward. You’ll be encouraged to start moving around as soon as possible. This is an essential part of your recovery. Even if you have to stay in bed it’s important to do regular leg movements and deep breathing exercises. A physiotherapist or nurse will explain these to you.
After the operation, you may have some of the following in place for a short time:
After your operation you’ll need painkilling drugs for a few days. These may be given into the space around your spinal cord (epidural), into a vein (intravenously), into a muscle (intramuscularly) or as tablets.
For the first few days you may be given painkillers into the space around the spinal cord. This is called epidural anaesthesia. It numbs the nerves in the part of your body where you’ve had your operation.
Before the operation a fine tube is placed into your back, close to the spinal cord nerves. The tube is attached to a syringe in an electronic pump. The pump gives you a continuous infusion of medicines to numb your nerves and control pain. You may also have a hand control with a button you can press if you feel sore. This is called patient controlled epidural analgesia (PCEA). It is designed so that you can’t have too much painkiller (overdose), so it’s okay to press it whenever you are uncomfortable.
Because the tube in your back is very fine, you can still lie on your back when you have an epidural in place. You are also able to sit up and walk around while having this type of pain control.
Some people are given painkilling drugs into a vein. These can also be given continuously through an electronic pump.
It’s important to let your doctor or the nurses on the ward know if you are in pain so that the dose can be increased or the painkillers changed as soon as possible. When you are ready to go home, your pain will be controlled with tablets, and you’ll be given a prescription of painkillers to take as needed at home.
If you’ve had a part of your pancreas removed, immediately after the operation the remaining pancreas may not be able to make enough insulin to control your blood sugar. You may need to have insulin given by injection into a vein (intravenously). This is usually only until the remaining pancreas recovers and starts to make insulin again. If you have an operation to remove all of your pancreas, you’ll need to continue with daily insulin injections. These are given under the skin (subcutaneously).
You may also need to take capsules containing the digestive enzymes normally made by the pancreas. Digestive enzymes help your body to break down and absorb fats and protein.
If you don’t have enough of them, you may have diarrhoea or your stools may float, look pale and smell offensive. You’ll also find it difficult to put on weight because you can’t absorb nutrients from your food.
If your duodenum becomes blocked by the cancer, food or drink can’t pass through to your bowel and builds up in your stomach. This makes you feel sick and causes vomiting.
An operation to bypass the blockage can help. The surgeon connects the part of your small bowel that comes just below the duodenum directly to your stomach. This allows food to pass from the stomach into your bowel. This operation is often done at the same time as an operation to relieve a blocked bile duct.
If cancer blocks the bile duct, causing jaundice|, your doctors may suggest you have a procedure to relieve the blockage and allow bile to flow into the small bowel again. The jaundice will then clear up.
A blocked bile duct can be treated with an operation to bypass the blockage (bile duct bypass), or you may have a flexible tube called a stent put into the bile duct to hold it open.
The bile duct (or occasionally the gall bladder) is cut above the blockage and reconnected to the small bowel. This bypasses the blocked part of the bile duct and allows the bile to flow from the liver into the bowel. In some hospitals, it’s possible to do this procedure during laparoscopy|.
A stent is a flexible plastic or metal tube that can be put into a duct or the section of bowel that’s blocked by cancer. The stent holds the duct or bowel open, allowing fluid to pass through it. Sometimes a stent needs to be replaced if jaundice comes back or if an infection occurs.
Stents are most commonly put in using an ERCP| but can also be put in during a procedure called a percutaneous transhepatic cholangiogram (PTC).
If a stent can’t be passed into the bile duct during ERCP, a PTC may be carried out. This involves having an x-ray taken of your bile ducts.
You will be asked not to eat or drink for a few hours before a PTC. The procedure is carried out in the x-ray department by a doctor called a radiologist. Once you are lying down, you are given a sedative so that you feel relaxed and drowsy.
You have an injection of local anaesthetic into the skin to numb it. The doctor then inserts a long, thin, flexible needle through the skin into the liver. They look at x-ray images on a screen as they guide the needle to the bile duct and inject a dye.
Some people feel warm all over when the dye is injected. This is normal and the feeling wears off quickly.
The dye flows through the ducts, showing the area that is blocked. The doctor passes a fine guide wire along the needle into the blockage in the bile duct. A plastic or metal tube (stent) is then passed along this wire. The stent holds open the bile duct where it has narrowed, allowing fluid to flow through it again. You may feel some pushing when the wire and stent is being put in. If this is uncomfortable or painful, let the doctor know so that you can be given painkillers.
To help prevent infection you will be given antibiotics before and after the procedure. You will probably need to stay in hospital for a few days.
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