Surgical Treatment Options for Pancreatic Cancer

Surgeons use this for pancreatic tumors or precancerous lesions that form in the tail (left side) of the pancreas.

Distal pancreatectomy can either be open surgery or minimally invasive (laparoscopic or robotic).

During the procedure, surgeons remove the tail and part of the body of the pancreas. They often will also remove the spleen.

Because the spleen helps fight infection, you'll need a vaccine before surgery and at specific intervals after.

In most cases, you'll need to stay in the hospital between four and eight days.

A robotic distal pancreatectomy:

• Is a minimally invasive surgery.
• Removes the tail and body of the pancreas through five or six small "keyhole" cuts.
• Can reduce risks and shorten hospital stays by a few days.

Tumor enucleation (TE) is a technique that preserves the pancreas while removing one or more tumors. It's a good option for localized tumors that haven't spread to neighboring structures.

Surgeons often use this approach to manage small (less than 2 cm.), non-functional neuroendocrine tumors.

TE lessens the risk of diabetes or pancreatic insufficiency development.

Surgeons mostly use minimally invasive robotic or laparoscopic techniques.

During a pancreatic TE, the surgeon:

• Uses ultrasound to create dynamic, hi-res pictures of the pancreas.
• Removes the isolated pancreatic tumor.
• Preserves the remaining pancreatic tissue.
• Doesn't remove any other organs.

The superior mesenteric vein (SMV) transports blood from the small and large intestines. It merges with the splenic vein at the level of the pancreatic head.

Together, they form the hepatic portal vein (PV). This vein carries blood to the liver.

Surgeons use resection and repair in cases where a tumor invades the SMV or PV.

Your surgeon may remove the affected vein and form a new path to the liver to ensure steady blood flow.

When deemed necessary for tumor treatment, they can do resection and repair during other pancreatic surgeries, such as a:

• Whipple procedure.
• Total pancreatectomy.
• Distal pancreatectomy on occasion.

With this treatment, surgeons remove:

• The head of pancreas and the attached duodenum and bile duct.
• A small part of the stomach (commonly less than 5%).
• The gallbladder.

Surgeons may choose to use open Whipple surgery in certain cases, such as when:

• You have a history of multiple prior open abdominal surgeries.
• Your anatomy isn't suited for a minimally invasive approach.
• You need complex SMV, PV, or arterial reconstruction.

The open Whipple requires a large incision, often extending from the breastbone to the belly button. Most people will need to stay in the hospital for about six to 10 days.

In contrast, a minimally invasive robotic Whipple requires only a few minor cuts — usually 5 to 8 mm. — leading to:

• A shorter hospital stay.
• A quicker recovery.
• Less pain and scarring.

Advanced Whipple surgery

This surgery has all aspects of the standard Whipple but includes vein reconstruction.

DP-CAR removes locally advanced cancers affecting the pancreatic neck and body, especially in the celiac trunk or hepatic artery.

Surgeons can conduct DP-CAR through either an open approach or a minimally invasive method, such as robotic surgery.

At UPMC, we specialize in the minimally invasive approach and have performed numerous, successful robotic DP-CAR procedures.

Your surgeon will provide guidance on what approach will best meet your needs.

The objective of surgical treatment for pancreatic cancer depends on the potential for complete tumor removal. Surgery is often just one element of your care plan.

If your surgeon:

• Decides it's feasible to remove the entire tumor, then the goal is to provide a chance for curing the cancer.
• Sees that the tumor has extensively spread, making complete removal impossible, then the goal of surgery is to ease symptoms.

It's crucial to know that imaging tests may not always offer a precise forecast of the surgical scenario. Surgeons may need to adjust their approach mid-surgery based on their findings and the actual extent of the disease.

Pancreatic cancer surgery can lead to various short- and long-term side effects and risks.

Some potential effects include:

• Bleeding.
• A new diabetes diagnosis or worsening of pre-existing diabetes.
• Diarrhea.
• Increased gas.
• Risk of infections.
• Stomach pain.
• Weight loss.

In some cases — due to the nature of pancreatic cancer growth — surgeons may be unable to fully remove the tumor. This is when the focus of the surgery shifts to easing cancer-related symptoms.

Also, surgery alone may not fully get rid of cancer or its potential spread to other parts of the body.

Follow-up visits and further treatments remain are vital for managing the disease effectively.

Recovery time after pancreatic surgery can vary, but here's a broad timeline:

• Hospital stay. For most people, it takes between six and 10 days in the hospital to recover right after surgery.
• At home. After discharge, you continue healing at home. Your care team will give you detailed steps before you leave the hospital.
• Complete healing. Full healing from pancreatic surgery may take up to three months.

Factors that can affect how long it takes to recover include:

• Your overall health. Existing health problems can impact the recovery period.
• The type and complexity of surgery. What type of pancreatic surgery you had and how complex it was can affect how long it takes to recover.
• Post-op setbacks. Any complications or setbacks after the surgery can extend the recovery period.

Ongoing follow-up visits are vital for making sure your recovery is on track.

Pancreatic cancer is a serious condition. The five-year relative survival rate for all stages of pancreatic cancer is 12%.

But multimodal therapy and successful surgical resection can increase this rate to more than 25%.

Early diagnosis and timely treatment play crucial roles in improving overall survival rates.

Not every person with pancreatic cancer is a candidate for surgery, and the success rate varies.

The prognosis following surgery depends on your overall health and key factors such as the:

• Stage of pancreatic cancer.
• Size of the tumor and its involvement with major blood vessels.
• Extent of cancer's spread, whether beyond the pancreas or within the organ itself.

Your care team will give you a more detailed prognosis tailored to your unique case.

Be sure to ask them any questions or discuss your concerns. They're here to help you make informed decisions about your treatment.

Yes, it's possible to live without a pancreas, but it has major life-changing consequences.

When you lack a pancreas, your body can't make insulin and other essential hormones that help regulate blood sugar levels.

This means you:

• Will require insulin therapy for the rest of your life to manage your blood sugar levels.
• May also need enzyme pills to help digest certain foods, as the pancreas plays a role in producing digestive enzymes.

Living without a pancreas and digestive enzymes involves careful diabetes management and diet and lifestyle changes. It's a life-changing condition that requires ongoing medical care.