Pancreatic cancer surgery aims to remove the cancer when it can be safely and completely removed. The type of surgery recommended depends mainly on where the tumour is located in the pancreas, how far it has spread, whether nearby blood vessels are involved, and the person's overall health.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
There is no single operation that is suitable for every pancreatic cancer. The most common surgical procedures include the Whipple procedure, distal pancreatectomy, and total pancreatectomy. In some situations, surgery may instead be performed to relieve symptoms caused by a blocked bile duct or intestine rather than to remove the cancer itself. Learn more about pancreatic cancer surgery and treatment options.
What Determines the Type of Pancreatic Cancer Surgery?
Before recommending surgery, the medical team evaluates the location and extent of the tumour. Imaging tests such as CT or MRI scans help doctors understand the size and position of the tumour and its relationship with nearby organs and major blood vessels.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Doctors also consider whether the cancer is resectable, meaning it appears possible to remove the cancer completely. Some tumours are considered borderline resectable because they involve or are close to important blood vessels and may require treatment such as chemotherapy before surgery.
Other factors, including overall health, nutritional status and the ability to tolerate a major operation, can also influence the treatment plan.
1. Whipple Procedure
The Whipple procedure, also called a pancreaticoduodenectomy, is the most common operation for pancreatic cancers located in the head of the pancreas.
During a Whipple procedure, the surgeon removes the head of the pancreas along with nearby structures that may contain or be closely connected to the cancer. These can include part of the small intestine, part of the bile duct, the gallbladder, nearby lymph nodes and, in some cases, part of the stomach.
The remaining pancreas and bile duct are then connected to the small intestine so that digestive juices and bile can continue to enter the digestive tract. The Whipple procedure is a complex operation, and recovery can take several weeks or longer. Some patients may experience changes in digestion, weight loss, delayed stomach emptying or changes in blood sugar after surgery. The exact procedure can vary depending on the location of the tumour and the patient's anatomy.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
2. Distal Pancreatectomy
A distal pancreatectomy is generally used for pancreatic cancers located in the body or tail of the pancreas. During this operation, the surgeon removes the affected portion of the pancreas. The spleen is often removed at the same time, although whether the spleen can be preserved depends on the location and extent of the cancer.
Because the spleen helps protect the body against certain infections, people who undergo spleen removal may need recommended vaccinations and other precautions. After a distal pancreatectomy, some patients may experience changes in digestion or blood sugar control. The extent of these changes depends partly on how much pancreatic tissue is removed and how well the remaining pancreas functions.
3. Total Pancreatectomy
A total pancreatectomy involves removing the entire pancreas. It is used less often than a Whipple procedure or distal pancreatectomy and may be considered in selected cases when removing the whole pancreas is necessary to achieve adequate cancer removal.
Depending on the situation, the operation may also involve removal of the gallbladder, bile duct, spleen and portions of the stomach or small intestine, along with nearby lymph nodes.
Because the entire pancreas is removed, the body can no longer produce insulin from the pancreas or produce pancreatic digestive enzymes. As a result, people who undergo total pancreatectomy require lifelong insulin treatment and pancreatic enzyme replacement to help control blood sugar and digest food.
4. Palliative Surgery for Pancreatic Cancer
Not all pancreatic cancer surgeries are performed to remove the tumour. When the cancer cannot be completely removed, a procedure may sometimes be used to relieve symptoms or prevent complications.
For example, a pancreatic tumour can block the bile duct and cause jaundice. It can also block the duodenum, making it difficult for food to pass from the stomach into the intestine.
In selected situations, surgeons may perform a bypass procedure to reroute bile or food around the blockage. Other treatments, such as placing a stent, may also be considered depending on the patient's condition. The goal of these procedures is to improve symptoms and quality of life rather than remove all of the cancer.
Can Pancreatic Cancer Surgery Be Done Using Minimally Invasive Techniques?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Some pancreatic operations can be performed using laparoscopic or robotic-assisted surgery. These approaches use smaller abdominal incisions and specialised instruments.
However, minimally invasive surgery is not suitable for every patient. The decision depends on factors such as the type of operation required, tumour location and size, involvement of nearby blood vessels, previous abdominal surgery and the surgeon's experience with the procedure. For complex pancreatic cancers, an open operation may still be the most appropriate approach.
How Do Doctors Decide Which Surgery Is Right?
The choice of surgery is usually based on several factors, including:
- Tumour location: Whether the cancer is in the head, body or tail of the pancreas.
- Extent of the cancer: Whether the tumour has spread outside the pancreas.
- Blood vessel involvement: Whether the tumour is close to or has grown into nearby major blood vessels.
- Resectability: Whether doctors believe the cancer can be completely removed.
- Overall health: Whether the person is fit enough to undergo major surgery.
- Response to other treatment: In some cases, chemotherapy or other treatment may be given before surgery.
What Happens After Pancreatic Cancer Surgery?
Recovery depends on the type and extent of surgery performed. Patients may initially need monitoring in the hospital before gradually returning to eating, drinking and normal activity.
Because the pancreas plays an important role in digestion and blood sugar regulation, some people may experience digestive changes or problems controlling blood sugar after surgery. Pancreatic enzyme replacement therapy or diabetes treatment may be recommended when needed.
Further treatment may also be recommended after surgery. Depending on the cancer and the individual's treatment plan, this can include chemotherapy or other cancer treatments.
Bottom Line
The type of pancreatic cancer surgery depends largely on where the tumour is located and whether it can be completely removed. The Whipple procedure is generally used for cancers in the head of the pancreas, while distal pancreatectomy is commonly used for cancers in the body or tail. Total pancreatectomy is reserved for selected cases where removing the entire pancreas is necessary.
Because pancreatic cancer surgery is complex, the recommended procedure should be based on detailed imaging, cancer staging, overall health and assessment by an experienced multidisciplinary team.
