Pancreatectomy can be an important part of treatment for pancreatic cancer when the tumor can be removed completely. However, not every pancreatic cancer can be treated with surgery.
Doctors first need to determine whether the cancer is resectable, meaning it can potentially be removed completely while leaving the patient with an acceptable chance of benefiting from the operation.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
If you are looking for an overview of the procedure itself, our Pancreatectomy guide explains the different types of pancreas removal surgery. For pancreatic cancer specifically, however, the key question is often whether surgery is possible at all.
When Is Pancreatectomy Possible for Pancreatic Cancer?
Pancreatectomy may be possible when imaging and other evaluations show that the cancer can be completely removed and has not spread in a way that makes surgery unlikely to provide meaningful benefit.
Doctors generally classify pancreatic cancer into three broad groups when deciding whether surgery may be appropriate:
- Resectable: The tumor appears removable with surgery, without extensive involvement of major nearby blood vessels or distant spread.
- Borderline resectable: The tumor has a close or limited relationship with certain nearby blood vessels, making complete removal more challenging, but surgery may still be possible, often after treatment given before surgery.
- Unresectable: The cancer cannot currently be completely removed with surgery, either because of extensive local involvement or because it has spread to distant organs.
What Does “Resectable” Pancreatic Cancer Mean?
Resectable pancreatic cancer is cancer that appears to be confined to the pancreas or has only limited extension nearby and can potentially be removed completely.
One of the most important considerations is the relationship between the tumor and the major blood vessels surrounding the pancreas. If the tumor has not grown into or extensively involved these vessels, complete surgical removal may be possible.
The patient also needs to be medically fit enough to undergo a major operation. Therefore, resectability is not determined by the scan alone. The surgical team also considers the person's general health, nutritional condition, heart and lung function, and ability to recover from major surgery.
What Does Borderline Resectable Mean?
Borderline resectable means that the cancer may still be removable, but there is a greater concern about whether the entire tumor can be removed safely and with clear margins.
This classification is often related to the tumor's involvement with nearby major blood vessels. The exact criteria depend on which blood vessels are involved and how extensively the tumor contacts or surrounds them.
Patients with borderline resectable pancreatic cancer may receive neoadjuvant treatment, usually chemotherapy with or without radiation in selected situations, before surgery.
The purpose is to treat cancer cells throughout the body early, assess how the cancer responds and, in selected patients, improve the possibility of achieving a complete surgical removal.
Can Borderline Resectable Pancreatic Cancer Become Operable?
In some patients, yes. Borderline resectable disease is not the same as permanently unresectable cancer. After treatment before surgery, doctors reassess the disease using imaging and other appropriate tests.
If there is no evidence of progression or distant spread and the tumor remains technically removable, surgery may be considered.
The decision is individualized and usually involves a multidisciplinary team that may include pancreatic surgeons, medical oncologists, radiation specialists, radiologists and other healthcare professionals.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
When Is Pancreatic Cancer Considered Unresectable?
Pancreatic cancer may be considered unresectable when it cannot be completely removed without unacceptable risk or when the cancer has spread beyond the area that can be treated effectively with pancreatic surgery.
Two important situations are:
Locally advanced pancreatic cancer
The cancer has not spread to distant organs but has grown extensively into or around important nearby structures, particularly major blood vessels, making complete surgical removal technically unsuitable at that point.
These patients are generally treated with systemic therapy and, in selected cases, radiation-based treatment. Some patients whose disease responds well to treatment may later be reassessed for surgery.
Metastatic pancreatic cancer
Metastatic pancreatic cancer has spread to distant organs or tissues, commonly including the liver, lungs or peritoneal cavity.
When pancreatic cancer has distant metastases, surgery to remove the primary pancreatic tumor is generally not used as a curative treatment. Treatment is usually focused on controlling the cancer throughout the body and managing symptoms.
Does the Stage of Pancreatic Cancer Determine Whether Surgery Is Possible?
Stage is important, but it does not tell the whole story. Pancreatic cancer is commonly staged using the TNM system, which considers the tumor, nearby lymph nodes and distant spread.
At the same time, doctors use the terms resectable, borderline resectable and unresectable to describe whether the cancer can potentially be removed completely.
As a result, two patients with the same broad stage may not necessarily have the same surgical options. Tumor location, blood-vessel involvement, distant spread and the patient's overall condition can all affect the treatment plan.
Why Do Blood Vessels Matter in Pancreatic Cancer Surgery?
The pancreas is located close to several major blood vessels. A pancreatic tumor can come into contact with, surround or grow into these vessels. This relationship is carefully evaluated because removing a tumor that involves a major vessel may be technically complex.
In selected cases, experienced pancreatic surgeons may be able to remove and reconstruct an involved blood vessel as part of the operation, but this depends on the specific anatomy and extent of disease.
Therefore, blood-vessel involvement does not always mean exactly the same thing for every patient. The detailed imaging findings need to be reviewed by a specialist surgical team.
What Tests Are Used to Decide if Surgery Is Possible?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Determining whether pancreatic cancer is resectable requires detailed evaluation. Tests may include:
- Contrast-enhanced CT scan: Often central to evaluating the tumor, nearby structures and blood-vessel involvement.
- MRI: May provide additional information about the pancreas, bile ducts, liver and other structures in selected patients.
- Endoscopic ultrasound: Can provide detailed images of the pancreas and may also be used to obtain tissue samples when appropriate.
- Blood tests: These may include liver-function tests and tumor-marker testing such as CA 19-9, interpreted in the appropriate clinical context.
- Staging laparoscopy: In selected patients, a minimally invasive procedure may be used to look for cancer spread that is not clearly visible on imaging.
The exact combination of tests depends on the patient's symptoms, imaging findings, suspected tumor type and treatment plan.
Which Pancreatectomy Is Used for Pancreatic Cancer?
The location of the tumor largely determines which part of the pancreas needs to be removed.
Whipple procedure
The Whipple procedure, also called pancreaticoduodenectomy, is commonly performed for cancers located in the head of the pancreas.
The operation removes the pancreatic head along with nearby structures that may include part of the small intestine, bile duct, gallbladder and nearby lymph nodes. Depending on the specific operation, part of the stomach may also be removed.
Distal pancreatectomy
A distal pancreatectomy is generally used for tumors located in the body or tail of the pancreas. The surgeon removes the affected portion of the pancreas. The spleen is often removed at the same time, depending on the tumor and surgical approach.
Total pancreatectomy
Total pancreatectomy removes the entire pancreas. It may be considered in selected situations when the cancer involves a large portion of the pancreas or when removing the entire gland is necessary to achieve appropriate tumor clearance.
Because the pancreas produces insulin and digestive enzymes, living without a pancreas requires lifelong management of blood sugar with insulin and replacement of pancreatic digestive enzymes.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Can Pancreatic Cancer Look Operable on a Scan but Be Unresectable During Surgery?
Yes. Imaging provides detailed information, but it cannot always identify every area of cancer spread. Sometimes a tumor appears removable before surgery, but the surgeon discovers that the cancer has spread or involves structures in a way that prevents complete removal.
In such circumstances, continuing with a major pancreatic resection may provide little benefit while exposing the patient to significant risks.
The surgical team may therefore stop the planned resection or perform a more limited procedure when appropriate, particularly if the goal is to relieve or prevent complications rather than remove the cancer completely.
Can Surgery Cure Pancreatic Cancer?
Surgical removal offers the best potential for long-term survival and is the only treatment that can potentially provide a cure for localized pancreatic cancer. However, surgery does not guarantee that the cancer will not return.
Pancreatic cancer can spread microscopically before it is detected on imaging. For this reason, surgery is often combined with systemic treatment such as chemotherapy as part of an overall treatment strategy.
The likelihood of benefit depends on factors such as the extent and biology of the cancer, whether complete removal is achieved, lymph-node involvement, response to treatment and the patient's overall condition.
What If Surgery Is Not Possible?
Not being a candidate for pancreatectomy does not mean that treatment is unavailable.
Depending on whether the cancer is locally advanced or metastatic, treatment may include chemotherapy, selected radiation-based treatments, targeted or other systemic therapies when appropriate, and clinical trials.
Supportive or palliative treatments may also be used to manage problems such as bile-duct blockage, intestinal obstruction, pain, nutritional difficulties or other symptoms. The goal may be to control the cancer, slow its progression and maintain quality of life.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The Bottom Line
Pancreatectomy for pancreatic cancer is possible when the tumor can be removed completely and the patient is fit enough to undergo a major operation. The most important distinction is whether the cancer is resectable, borderline resectable or unresectable.
Resectable cancers may be treated with surgery, while borderline resectable cancers may receive treatment before surgery and then be reassessed. Locally advanced or metastatic cancers generally cannot be treated with curative pancreatic surgery, although selected patients with locally advanced disease may become surgical candidates after treatment.
Ultimately, the decision depends on detailed imaging, the tumor's relationship with nearby blood vessels and organs, whether the cancer has spread, the patient's overall health and the assessment of an experienced multidisciplinary team.
