Pancreatic Cancer Surgical Options
For many types and stages of pancreatic cancer, surgery is the treatment of choice.
What is the Goal of Surgery for Pancreatic Cancer?
The goal of surgical treatment for this disease depends on the likelihood of removing the tumor.
- If imaging test results suggest surgeons can excise the entire mass then the goal of surgery is to cure the pancreatic cancer.
- If the imaging test results suggest the tumor is too large or widespread for surgeons to remove then the goal of surgery is to relieve symptoms or prevent complications (palliative surgery).
Imaging tests can't always predict exactly what the surgeon will encounter. He or she may need to switch from curative to palliative surgery based on the situation at hand.
Surgical Treatment Options for Pancreatic Cancer
The surgical oncologists at UPMC Hillman Cancer Center have extensive skill in a range of advanced pancreatic cancer surgery techniques.
Minimally invasive and robotic surgical methods — including the robotically assisted Whipple procedure — reduce risks and healing times.
Almost 80 percent of pancreatic cancer patients at UPMC who we recommend for surgery have the Whipple procedure. And, up to 85 percent of patients slated for the Whipple procedure are candidates for the robotic option.
UPMC is one of only a handful of hospitals in the United States to offer the robotic Whipple method.
Your care team and surgeon will:
- Explain your pancreatic cancer surgical treatment options.
- Recommend the option that takes into account the type and stage of pancreatic cancer, along with the goals of surgery.
- Discuss the risks and benefits of the procedure and describe the recovery process.
You will also make decisions together about adding radiation or medical oncology to your treatment plan either before or after surgery.
Types of pancreatic cancer surgeries we perform
- Distal pancreatectomy — this is the removal (resection) of the tail and some of the body of the pancreas. Used mainly for neuroendocrine (islet cell) tumors, this open surgery often includes removal of the spleen. Because the spleen helps fight infection, you may need a vaccination before surgery. This operation usually requires a hospital stay of six to eight days.
- Laparoscopic pancreatectomy — this minimally invasive procedure removes the tail and body of the pancreas through five or six small “keyhole” incisions. This can reduce risks and shorten hospital stay by a few days.
- Pancreas-sparing tumor resection — in this type of limited resection, the surgeon removes the tumor without removing the pancreas. Contained tumors that haven't invaded nearby structures may be entirely resectable. Sometimes, the surgeon will resect a tumor along with part of a structure (usually the duodenum) that it has invaded.
- Portal vein resection and reconstruction — at the head of the pancreas, the superior mesenteric vein meets the splenic vein. These form the hepatic portal vein, which transmits blood to the liver. If a tumor invades this meeting point, the surgeon may resect it and build a new pathway to the liver. Surgeons can perform portal vein resection along with the Whipple procedure or on its own.
- Whipple procedure (Pylorus preserving pancreaticoduodenectomy) — this open method removes a tumor in the head of the pancreas along with the attached duodenum and bile duct. Surgeons also remove the gallbladder and part of the stomach. The open Whipple procedure requires a large incision and usually entails a hospital stay of about ten days. The minimally invasive robotic Whipple method requires a few small incisions. This results in a shorter hospital stay, faster recovery, and reduced pain and scarring.
- Advanced Whipple — this surgery contains all aspects of the standard Whipple along with the removal if the portal or superior mesenteric veins.
- Appleby operation — this is the removal of locally advanced cancers of the body of the pancreas that have invaded the celiac or hepatic artery. Robotic methods are not available for this operation.
- Small bowel (small intestine) resection — this is the resection of the pancreatic tumor along with the part of the bowel that it has invaded.
- Total gastrectomy — extensive tumor involvement may require a total gastrectomy. This is when the surgeon removes some or all of the diseased pancreas along with the entire stomach and nearby lymph nodes. Often, this also involves removing the spleen and parts of the intestine as well. This radical surgery results in connecting the esophagus directly to the bowel.
Learn More About Surgery for Pancreatic Cancer
If you would like to learn more about pancreatic cancer care:
- Read Traditional vs. Robotic Whipple Procedure for Pancreatic Cancer at UPMC's HealthBeat blog.
- Contact UPMC Hillman Cancer Center at 412-647-2811.