Pancreatic Cancer Surgery

About 15 percent to 20 percent of patients with pancreatic cancer are diagnosed early enough that their tumor can be removed surgically. Typically, however, only smaller tumors are surgically removed and even then, cancer often returns.

Pancreatic cancer surgery is a complex procedure. Studies have found that patients do better overall when their surgery is performed at a medical center with a high volume of these surgical procedures. Although the definition of high volume varies by study, UCSF surgeons perform major pancreatic surgeries at a rate well above that which is considered high volume. We are among the most experienced and successful in performing this exacting surgery to treat pancreatic cancer.

Surgery may be performed to remove all or part of the pancreas and nearby tissue. Surgery is also used to try to minimize the complications caused by pancreatic cancer. The kind of surgery recommended depends on your type of cancer, location of the tumor, your symptoms, whether the cancer involves other organs and whether the cancer can be completely removed. It is important to note that even after having surgery, the cancer often recurs.

If imaging studies show that all of your tumor may be potentially removed, one of the following procedures may be performed:

• Whipple Procedure (Pancreaticoduodenectomy) — This is the most commonly performed surgery used to remove tumors of the pancreas. The surgeon removes the head of the pancreas, and sometimes the body of the pancreas. The bottom section of the stomach, parts of the small intestine, gallbladder, a portion of the bile duct and lymph nodes near the pancreas are also removed. The remaining tail of the pancreas and bile duct is reattached to the small intestine so that bile from the liver can flow into the small intestine.
• Distal Pancreatectomy — The surgeon removes the body and the tail of the pancreas. The spleen is also often removed.
• Total Pancreatectomy — In this procedure, the entire pancreas, duodenum, bile duct, gallbladder, spleen and nearby lymph nodes are removed. While a total pancreatectomy is usually effective in removing the cancer, it induces permanent diabetes, requiring patients to take insulin shots or use an insulin pump for the rest of their lives. This is because the pancreas contains Islets of Langerhans — also known as islets or islet cells — that secrete insulin to regulate the body’s blood sugar levels. In some cases, the cancer cannot be completely removed and other surgeries and procedures can be considered to alleviate symptoms.
• Biliary Bypass — This surgery is performed if cancer blocks the free flow of bile juice through the bile ducts. This obstruction can cause pain, infection, digestive problems and jaundice, a yellowing of the eyes and skin. Biliary bypass involves rerouting the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas.