Types of surgery for pancreatic cancer
What are the types of surgery?
Sometimes, it is possible to remove all of the cancer with surgery. This is a major operation. It is usually only suitable for people with early-stage pancreatic cancer. In some people, it may cure the cancer.
Only a specialist surgeon who has experience in pancreatic cancer surgery will do this type of operation. You may be referred to a specialist centre for it.
It is important to discuss the benefits and disadvantages with your surgeon before deciding to have surgery.
We have more information about preparing for surgery, and what to expect after surgery for pancreatic cancer.
The surgeon may remove part or all of the pancreas during the operation. This will depend on where the cancer is and how much of the pancreas it involves.
You may have one of the operations described below.
Modified Whipple’s procedure
In this operation, the surgeon removes:
- the head of the pancreas
- most of the first part of the small bowel (duodenum)
- the common bile duct
- the gall bladder
- the surrounding lymph nodes.
It is also called a pylorus-preserving Whipple’s procedure or pylorus-preserving pancreatico-duodenectomy (PPPD). A modified Whipple’s procedure is commonly used for people with cancer in the head of the pancreas.
Whipple’s procedure
This operation is similar to a modified Whipple’s procedure (PPPD). But the surgeon will also remove the lower part of the stomach. It is also called a pancreatico-duodenectomy or PD.
The sections in white are parts removed during a Whipple’s operation. These are the gall bladder, the head of the pancreas, and parts of the duodenum, stomach and common bile duct
The surgeon attaches the remaining parts of the stomach, the remaining bile duct, and the tail of the pancreas to the small bowel.
Pancreatectomy
A distal pancreatectomy is an operation to remove the lower end (body and tail) of the pancreas. The spleen is often removed at the same time. This is because it is close to the tail of the pancreas. The spleen helps you to fight infections. It is part of the lymphatic system.
A total pancreatectomy is an operation to remove the whole pancreas. This is a major operation and is rare. The surgeon will also remove:
- the duodenum
- part of the stomach
- the spleen
- the gallbladder
- part of the bile duct
- some lymph nodes.
If your spleen is removed during a distal or total pancreatectomy, you will need to have some vaccinations for the rest of your life to protect you from infections. You may also need to take antibiotics for the rest of your life. When you see other healthcare professionals, it is important to mention that you no longer have a spleen.
Keyhole (laparoscopic) surgery
Surgery for pancreatic cancer is usually open surgery, where the surgeon makes one large cut (incision). But in some specialist centres, the surgeons may do keyhole (laparoscopic) surgery.
Instead of one large cut, the surgeon will make several small cuts. They use a special instrument called a laparoscope to see into and work inside the tummy (abdomen).
Keyhole surgery is only suitable for a small number of people, and usually for people having a distal pancreatectomy.
A small number of specialist centres do keyhole surgery using robotic equipment. The camera on the end of the laparoscope gives a three-dimensional (3D) magnified view of the inside of the body. This is shown on a video screen to help guide the surgeon. The surgeon controls instruments attached to the robotic equipment.
The main advantage of keyhole surgery is that it leaves small wounds. This means you usually recover quicker.
About our information
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References
Below is a sample of the sources used in our pancreatic cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
European Society for Medical Oncology, Cancer of the pancreas: ESMO clinical Practice Guidelines. Volume 26, Supplement 5, V56-V68, 1 September 2015. Available from: https://doi.org/10.1093/annonc/mdv295 (accessed May 2021).
National Institute for Health and Care Excellence. Pancreatic cancer in adults: diagnosis and management. NICE guideline (NG85). Published 7 February 2018. Available at: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations (accessed May 2021).
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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