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Surgery is the most effective treatment for early-stage cancer of the pancreas. All or part of the pancreas is removed.
This is a major operation and is only suitable for people whose cancers are small and have not spread, and who are fit. It 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 to have this type of treatment. It is important to discuss the benefits and the 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 need to be removed during surgery.
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.
There are two types of bypass operations for people with cancer of the pancreas:
A bile duct bypass| can help treat jaundice. It involves joining the gall bladder or bile duct 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.
Sometimes the cancer presses on the first part of the bowel, called the duodenum. This blocks food from passing from the stomach into the small bowel, causing vomiting.
To relieve the blockage, the surgeon bypasses the duodenum by joining the stomach to the part of the small bowel beyond it (called the jejunum). This lets food pass into the bowel. This operation is called a gastrojejunostomy.
Quite often, surgeons do both operations at the same time, even in people who only have jaundice. This is because blockage of the duodenum can often develop later and doing the two by-pass operations together avoids the need for a second operation.
Having bypass surgery involves staying in hospital for a few days. It may be done by standard surgery or by 'keyhole' surgery, through a laparoscopy|.
You may find it helpful to look at the diagram of the pancreas|.
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.
A drip into a vein in your arm (intravenous infusion) will be used to give you fluids until you are able to eat and drink again.
You may have a fine tube that passes down your nose, into your stomach or small intestine. This is called a nasogastric tube and it allows any fluids in the stomach to be removed so that you don't feel sick. You may need this for up to five days.
Often a small tube (catheter) is put into the bladder, and urine is drained into a collecting bag. This will save you having to get up to pass urine and is usually taken out after a couple of days.
You may also have one or more drainage tubes in your wound, to collect any extra fluid or blood, or to drain bile or pancreatic fluid. These will be removed when the amount of fluid draining has reduced.
After your operation, you’ll probably have some pain| and discomfort for a few days.
Pain can usually be controlled effectively with painkillers.
It’s important to let your doctor or the nurses on the ward know if you are in pain, or if your drugs are not completely relieving your pain, so that the dose can be increased or the painkillers changed as soon as possible.
People who have had their whole pancreas removed will need to either take tablets to regulate their blood sugar, or have daily insulin injections to replace the insulin normally produced by the pancreas. They will need this for the rest of their life. They may also need to take capsules containing the special proteins (enzymes) normally produced by the pancreas, to help with digestion.
If you’ve had a part of your pancreas removed, immediately after the operation the remaining pancreas may not be able to produce enough enzymes to help with digestion, or 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 produce insulin again. You may also need to take capsules containing digestive enzymes normally made by the pancreas.
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