Surgery for pancreatic cancer

Some people who have early-stage pancreatic cancer have an operation to remove it (a resection). All or part of the pancreas may be removed, depending on where the cancer is and how much of the pancreas is involved.

One of the following operations may be done:

  • A pylorus-preserving pancreatoduodenectomy (PPPD), also called a modified Whipple’s operation. This involves removing the head of the pancreas, most of the duodenum, the common bile duct, gall bladder and the surrounding lymph nodes.
  • A pancreatoduodenectomy or Whipple’s operation. This is similar to the PPPD, but the lower part of the stomach is also removed.
  • A distal pancreatectomy (removal of the lower end of the pancreas).
  • A total pancreatectomy (removal of the whole pancreas).

In some specialist centres, the surgeon may carry out laparoscopic (keyhole) surgery for a distal pancreatectomy. Instead of one large cut (incision), you have several small cuts.

Surgery may also be done to relieve symptoms if pancreatic cancer blocks the bile duct or the bowel.

Surgery for cancer of the pancreas

Some people who have early-stage pancreatic cancer are able to have an operation to remove it. This operation is called a resection.

Surgery can also be used to relieve symptoms if the cancer is blocking the bile duct or the bowel.


Removal of the cancer (resection)

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. 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. You may need to be referred to a specialist centre for the operation.

It is important to discuss the benefits and risks with your surgeon before making the decision to go ahead with any surgery.

All or part of the pancreas may be removed during surgery. This will depend on where the cancer is, and how much of the pancreas is involved. One of the following operations may be done:

  • A pylorus-preserving pancreatoduodenectomy (PPPD), also called a modified Whipple’s operation. This involves removing the head of the pancreas, most of the duodenum, the common bile duct, gall bladder and the surrounding lymph nodes. It is most commonly used for people with cancer in the head of the pancreas.
  • A pancreatoduodenectomy or Whipple’s operation (see diagrams) – this is similar to the PPPD operation, but the lower part of the stomach is also removed.
  • Removal of the lower end (body and tail) of the pancreas (a distal pancreatectomy).
  • Removal of the whole pancreas (a total pancreatectomy). This involves removing the pancreas, duodenum, part of the stomach, the spleen, gallbladder and part of the bile duct and some lymph nodes. This is a major operation and is rarely done.

A Whipple’s operation
A Whipple’s operation

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The sections in white are the parts removed during a Whipple’s operation.

 After a Whipple's operation
After a Whipple's operation

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The surgeon attaches the remaining part of the stomach, the remaining bile duct, and the tail of the pancreas to the small bowel.


Laparoscopic (keyhole) surgery

In some specialist centres, the surgeon may carry out laparoscopic (keyhole) surgery. This can be used for a distal pancreatectomy. Instead of one large cut (incision), you have several small cuts. The surgeon uses a special instrument called a laparoscope to see and work inside the tummy.

A small number of hospitals carry out keyhole surgery using robotic equipment. The camera on the end of the laparoscope produces a 3D magnified view of the inside of the body on a video screen to help guide the surgeon. Instruments attached to the robotic equipment are then controlled by the surgeon.

The main advantage of keyhole surgery is that it leaves a small wound so recovery is usually quicker. This operation is not available in many hospitals and is not suitable for everyone.

Keyhole surgery is only carried out by surgeons who specialise in both pancreatic cancer and laparoscopic procedures.


Surgery to relieve symptoms

Bypass surgery for a blocked bowel

If the first part of your small bowel (the duodenum) becomes blocked by the cancer, food or drink can’t pass from your stomach to your bowel. The food builds up in your stomach, and can make you feel sick (nausea) and be sick (vomiting).

An operation to bypass the blockage can help. The surgeon connects the part of your small bowel 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.

Another way of treating a blockage in the duodenum is to place a tube called a stent in the duodenum.

Bypass surgery for a blocked bile duct

If cancer blocks the bile duct causing jaundice, your doctors may suggest you have a tube called a stent placed in the bile duct. This can be done during an endoscopy. If this is unsuccessful or not possible, you may be offered surgery to relieve the blockage.

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. The jaundice will then clear up. In some hospitals, it’s possible to do this procedure during a laparoscopy (see above).

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

What happens after surgery?

You’ll be monitored closely after your operation. How quickly you recover will depend on the surgery you’ve had.