Pancreatic Cancer Surgery
Surgery can be performed as a potentially curative measure if the cancer is contained within the pancreas and has not metastasized (spread) to blood vessels, lymph nodes or other organs. The American Society of Clinical Oncology estimates that only about 20 percent of pancreatic cancer patients qualify for this type of surgery.
At the time of diagnosis, most patients with pancreatic cancer already have metastatic disease. These patients would not benefit from the surgical removal of their primary tumor. However, surgery may be used to relieve symptoms or prevent complications in metastatic cancer patients. Your physician will help determine if surgery is a viable treatment option.
For surgical candidates, the type of operation performed for the removal of pancreatic cancer is based on the stage and location of the tumor.
Minimally Invasive Pancreatic Surgery
Minimally invasive or laparoscopic surgical techniques can sometimes be used in pancreatic surgery, depending on the location of the tumor. Laparoscopic procedures are performed using small incisions in the abdomen through which telescope-guided instruments are placed.
Conventional surgeries require a longer incision and a wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce the patient’s blood loss and risk of infection. Your surgical oncologist can help determine whether you are a candidate for a minimally invasive procedure.
In a distal pancreatectomy, surgeons remove the body and the tail of the pancreas, leaving the head of the pancreas intact. In addition, the spleen is usually removed.
As the least common pancreatic cancer surgery, this procedure is used when tumors extend throughout the pancreas. In a total pancreatectomy, surgeons remove the entire pancreas, spleen, gallbladder, common bile duct and portions of the small intestine and stomach.
Most patients will be in the hospital for one to two weeks following the procedure. Removing the entire pancreas leaves patients unable to produce enzymes for digestion or insulin for controlling blood glucose (sugar) levels. As a result, following surgery, patients must take supplemental enzymes and insulin for the rest of their life.
Surgical margins are located at the edge or border of the pancreatic cancer tissue that is removed during surgery. Surgeons and pathologists work together to make sure that each patient's tumor margins around the surgical excision are evaluated during surgery. As the pathologist checks tumor margins under the microscope in real time, he or she can guide the surgical team toward remaining cancer cells located in the borderline areas of the tumor, indicating that additional tissue may need to be removed. In some cases, not all cancerous cells can be completely removed.
When a pathologist describes a margin as negative or clean, it means that the pathologist did not find any cancer cells at the edge of the tissue, suggesting that all cancer has been removed. When the margin is described as positive or involved, it suggests that not all cancer has been removed.
For more advanced cancers, surgery may be done to relieve or prevent problems such as a blocked bile duct or intestine. Palliative surgery is not used to cure the disease.
Potential New Therapies Help Outsmart Pancreatic Cancer
Pancreatic cancer is challenging to treat. A Johns Hopkins surgeon details the latest treatment breakthroughs.
Research teams around the world are working to uncover novel ways to attack this disease. Every day doctors learn more about how new treatments, such as immunotherapies, could help treat pancreatic cancer more effectively.