Having surgery for pancreatic cancer

Your surgeon and specialist nurse will explain your operation and what to expect before and after surgery. Some people have chemotherapy before surgery to shrink the cancer. 

We have more information about different types of surgery for pancreatic cancer.

We also have information about surgery and other treatments to control the symptoms of pancreatic cancer

Before your operation

If you smoke, try to give up or smoke less before your operation. This will lower your risk of chest problems, such as a chest infection. It will also help your wound to heal after the operation. Your GP can give you advice.

You may find it helpful to read our information on giving up smoking.

Pre-assessment clinic

You will go to a pre-assessment clinic for tests to check you are fit for the operation. These may include:

You will meet a member of the surgical team to discuss the operation. This is a good time to share any questions or concerns you have.

Tell your nurse as soon as possible if you think you may need help when you go home after surgery. This may be because you live alone or care for someone else. This will give them plenty of time to make arrangements for anything you need to go home.

Enhanced recovery programme

Some hospitals follow an enhanced recovery programme. This aims to reduce your time in hospital and to speed up your recovery. It also helps you become more involved in your own care. For example, you may get information about diet and exercise. Your doctor or nurse will explain this to you before your operation. 

They will also talk to you about any arrangements you will need to go home. Your doctor will tell you if an enhanced recovery programme is available and suitable for you.

Preventing clots

You will usually be admitted to hospital on the morning of the operation. You will be given elastic stockings (TED stockings) to wear during the operation and for some time afterwards. This is to stop a blood clot developing in your legs.

After surgery

Knowing what will happen when you wake up after your operation can help you feel less anxious. It also prepares your family and friends for what to expect. Your recovery time will depend on the type of surgery you have.

Most people receive care in an intensive care or high-dependency unit for a few days after their pancreatic cancer operation. This is routine and does not mean your operation went badly or had complications. Some hospitals use a machine  called a ventilator to help you breathe for a few hours. You will probably feel quite drowsy and may not remember much about the first days after your operation.

The nurses will encourage you to start moving about as soon as possible. This is an important part of your recovery. It will help prevent problems such as chest infections or blood clots. The nurses will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or a nurse can explain these to you.

Drips and drains

For a short time after the operation, you may have some of the following.

  • A drip going into a vein in your arm or neck (intravenous infusion)

    This gives you fluids until you can eat and drink again. It can also give you painkillers and other medications.

  • One or more drainage tubes coming from your wound

    These drain away fluids, such as blood, bile or pancreatic juices. You will have these drainage tubes until the amount of fluid draining away has reduced.

  • A fine tube that passes down your nose and into your stomach or small intestine 

    This is called a nasogastric tube. It drains fluids from your stomach so that you do not feel sick. You may need this for several days.

  • A small flexible tube (catheter)

    This will drain urine from your bladder into a collecting bag. This means you will not have to get up to pass urine. You will usually only have this for a couple of days.

Pain control

It is normal to have some pain and discomfort after your operation. This can be controlled with painkillers. If you are in pain, tell the nurses. They may need to change the dose or type of painkiller.

You may have a spinal block during the operation. This is an injection of long-lasting painkiller into the fluid around the spinal cord. It gives pain relief for up to 24 hours. Or you may have an epidural. This is a pump that continuously delivers painkiller into the spinal fluid through a fine tube.

Painkillers can also be given through a tube into a vein in your hand or arm (a cannula). The tube connects to a pump. This is called PCA (patient-controlled analgesia). You can give yourself an extra dose of painkiller when you need it by pressing a button. The machine is set so you get a safe dose and cannot have too much.

Before you go home, your pain will be controlled by tablets or patches. You will get a prescription for painkillers you can take at home as needed.

Eating and drinking

Straight after the operation, you will not be able to eat or drink. Until you can, you will have fluids through a drip. Some people have extra nutrition through the drip. Or you may have a feeding tube (NG tube). This is passed through the nose and into the stomach.

You can usually start drinking small amounts of fluid the day after the operation. The surgeon will tell you when you can. You may have supplement drinks for a few days. These will give you the nutrition you need to help your recovery.

Wound care

The surgeon will close the wound with stitches, clips or staples. The stitches are usually removed 10 to 14 days after the operation. Your practice nurse can do this if you have gone home. If you cannot leave home, a district nurse can visit you.

You may have antibiotics to help prevent wound infection. You will have a dressing covering your wound. This may be left undisturbed for the first few days.

It is important to let your nurse or doctor know straight away about any problems with your wound. Tell them if the wound becomes hot or painful, or if it begins to bleed or leak fluids, even after going home.

Going home

Depending on the type of operation, you can probably go home 5 to 10 days after surgery. Your doctor or specialist nurse will be able to give you more information.

You will have an appointment at an outpatient clinic for your post-operative check-up. This lets you discuss any further treatment you may need with them, such as radiotherapy or chemotherapy.

Replacing insulin and digestive juices

Insulin injections

If you have had part of your pancreas removed, your body may struggle to control blood sugar. This is because the remaining pancreas may not be making enough insulin. You may need to have insulin injections. This is usually only until the remaining pancreas recovers and starts to make insulin again.

If you have had your whole pancreas removed you will need daily insulin injections for life. These are given under the skin (subcutaneously). You will also need to check your blood sugar level regularly. A diabetes nurse will give you support and advice about insulin replacement. If you already have diabetes, you may have to increase your insulin or tablet dose.

Digestive juices

You may need to replace the digestive juices (enzymes) that the pancreas normally makes. This will depend on the type of operation you have had. Your surgeon or nurse or a dietitian will give you more information.

Digestive enzymes help your body to break down and absorb fats and protein. If you do not have enough of them, you may have diarrhoea. Your stools (poo) may float, look pale and smell bad. You will also find it difficult to put on weight because you cannot absorb nutrients from your food.

You can replace the digestive enzymes by taking capsules. You usually take these for every time you eat or have a milky drink for the rest of your life. Your nurse or a dietitian will explain how to take them. 

Commonly used pancreatic enzyme replacement therapy drugs are:

  • Creon®
  • Nutrizym®
  • Pancrease®
  • Pancrax®.

Most replacement enzymes are made from pork. Vegetarian based enzymes are not available. Creon, a pork-based enzyme replacement is the most commonly used supplement.  

Jewish and Muslim organisations support its use if there is no alternative. If you have concerns speak to your doctor or nurse.

About our information

  • 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

    British Society of Gastroenterology. Guidelines for the management of patients with pancreatic cancer peri-ampullary and ampullary carcinomas. 2005.

    European Society for Medial Oncology. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2015. 26 (Supplement 5): v56 to v68.

    Fernandez-del Castillo. Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer. UpToDate online. Jan 2018.

    Fernandez-del Castillo C, et al. Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer. UpToDate online. Feb 2017. 

    Winter JM, et al. Cancer of the pancreas, DeVita Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology (10th edition). Lippincott Williams and Wilkins. 2016.


  • 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 Senior Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.