Surgery is currently the most effective treatment for pancreatic cancer. The two types of surgery used to treat pancreatic cancer are potentially curative surgery and palliative surgery. Potentially curative surgery is performed if it appears the cancer can be removed entirely. If the cancer has spread too far to be completely removed, patients may be treated with palliative surgery. Rather than try to cure the cancer, the goals of palliative surgery are to relieve symptoms and prevent problems caused by the cancer, such as the cancer blocking the bile ducts or the intestine.
Potentially Curative Surgery
The type of operation performed depends on where the cancer is located within the pancreas. For cancers in the uncinated process, head, and neck, a Whipple operation is performed. The Whipple procedure (pancreatoduodenectomy) removes part of the pancreas, the first portion of the small intestine (duodenum), the gallbladder, and part of the bile duct, as well as several nearby lymph nodes. In some cases, a small portion of the stomach may also be removed. For cancers located in the body or tail of the pancreas, more often a distal pancreatectomy is performed. In this operation, part of the pancreas is removed along with the spleen and the surrounding lymph nodes.
After surgery, patients may require medication to aid pancreatic function, such as digestive enzymes and/or insulin.
Potentially curative surgery, such as the Whipple procedure, is only performed if the cancer can be entirely removed. Removing only part of the cancer does not help the patient live longer (American Cancer Society 2015a). In some cases, surgeons may begin potentially curative surgery, only to discover the cancer is too widespread to be removed entirely. In these instances, the procedure may be stopped, or the surgeon may perform palliative surgery.
For many patients, potentially curative surgery is not an option because the cancer is already too widespread to operate on when it is discovered. For these patients, palliative surgery may be an option. Palliative surgery is meant to treat the symptoms of the cancer and prevent problems that may potentially arise as a result of the cancer.
One problem palliative surgery may be able to treat is blockage of the bile duct. Having a blocked bile duct can not only be painful, it can also interfere with digestion and cause jaundice.
The two main options to relieve blockage are stent placement and bypass surgery.
Endoscopic Stent Placement
Stent placement is the most common procedure used to relieve blockage in the bile ducts. For this less invasive procedure, the gastroenterologist uses an endoscope to place small plastic or metal stents into the duct to relieve blockage. Larger stents can be used to relieve intestinal blockage.
Stents are not a permanent solution to blockage. Over time, the stents may become clogged and need to be replaced.
Operative Biliary and Intestinal Bypass
Instead of bile flowing from the common bile duct through the pancreas, bypass surgery redirects the flow of bile from the common bile duct into the small intestine. Additionally, if the duodenum or stomach is blocked by the tumor, a loop of intestine can be sewn to the stomach further up to allow food to be more easily digested.
The recovery time for bypass surgery is longer than for stent placement surgery, but this type of surgery offers longer-term relief.
American Cancer Society. 2015a. Pancreatic Cancer Overview. PDF.
-----2015b. “What are the risk factors for pancreatic cancer?” Last modified January 9, 2015.
American Joint Committee on Cancer. 2009. Pancreas Cancer Staging. 7th ed. PDF. https://cancerstaging.org/references-tools/quickreferences/Documents/PancreasSmall.pdf
National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Pancreas. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. https://www.mycareplusonline.com/sites/default/files/cmgfiles/WYNTK_Pancreas_Cancer.pdf