Surgery for pancreatic cancer
At the Pancreatic Cancer Center, our nationally recognized surgeons treat many pancreatic cancer patients each year. They have vast experience performing highly complex procedures such as Whipple surgery, and in treating common and rare forms of pancreatic cancer. This is important to consider when choosing care, as studies show that centers with higher volumes and more experience have fewer complications and better long-term outcomes following surgery.
At our center, you won't just be in the capable hands of some of the top pancreatic cancer surgeons in the country—you'll have access to a whole team of pancreatic cancer specialists, including medical oncologists, radiation oncologists, gastroenterologists, radiologists and pathologists, who work together to create a highly personalized treatment plan just for you.
Making the impossible, possible
Historically, surgery for pancreatic cancer was only offered to patients with early stage disease. But with new, effective treatment regimens and state-of-the-art protocols, we are helping more people with advanced pancreatic cancer become candidates for surgery.
Our team works hand in hand with medical oncologists to offer FOLFIRINOX (a groundbreaking combination of chemotherapy drugs) before surgery. Since we began using this approach, between 7% and 14% of our patients have become candidates for surgery, when before, their tumors were deemed completely unresectable. That's just one example of how doctors at Northwell are raising the standard of health care.
Operative resection surgery
After a definitive pancreatic cancer diagnosis, your surgeon may recommend pancreas removal surgery. This may include removing part or all of the pancreas, a small amount of healthy tissue around it and nearby lymph nodes that may be affected.
The type of surgery your doctor recommends will depend on the type of tumor you have, location and size, as well as whether it has advanced. For locally advanced and borderline resectable tumors, chemotherapy may be given before surgery as a preoperative treatment.
We offer the following surgical procedures:
Whipple surgery (removal of the head of pancreas)
Whipple surgery, also known as pancreaticoduodenectomy, is a traditional open surgery that is the most common for removing tumors from the pancreas. Most often, Whipple surgery is done through an incision down the middle of the abdomen, which is the widely used approach for the removal of pancreas tumors.
During this operation, the surgeon typically removes:
- The head of the pancreas, which is the wide end
- The body of the pancreas, which is the middle section (in some cases)
- The gallbladder and part of the common bile duct
- The duodenum, which is part of the small intestine
- Part of the stomach (in some cases)
- Surrounding lymph nodes
After the Whipple procedure, bile from the liver, food from the stomach and digestive juices from the remaining part of the pancreas all enter the small intestine, so the patient can have normal digestion.
Pylorus-preserving pancreaticoduodenectomy (preserves the stomach)
A pylorus-preserving pancreaticoduodenectomy is very similar to the Whipple procedure. However, the surgeon does not remove the lower part of the stomach.
Distal pancreatectomy (removal of the tail end of pancreas)
Your surgeon will perform a distal pancreatectomy if the cancer is confined to the tail of the pancreas. In this operation, only the tail of the pancreas (or the tail and a portion of the body of the pancreas) is removed. The spleen is usually removed as well.
Your spleen helps your body fight infections from three main forms of bacteria: pneumococcus, meningococcus and haemophilus influenzae. Vaccines will be given before surgery to prevent any infection.
A distal pancreatectomy can be performed either as a traditional open surgery or minimally invasively. The type of surgical technique your doctor recommends will depend mostly on the anatomical location of the tumor.
Central pancreatectomy (removal of the middle of pancreas)
Though rarely used, a central pancreatectomy is a procedure that removes a tumor in the middle of the body of the pancreas, while preserving the healthy head and tail. A benefit of a central pancreatectomy is that it leaves the patient with a highly functional pancreatic head and tail with exocrine and endocrine functions intact, therefore decreasing the chance of developing insulin-dependent diabetes.
Total pancreatectomy (removal of the entire pancreas)
A total pancreatectomy is performed less often than the other operations. It might be an option if the cancer has spread but can still be removed. During the procedure, your surgeon will remove:
- The entire pancreas
- The distal common bile duct
- The duodenum, which is part of the small intestine
- Part of the stomach
- The gallbladder
- The spleen—vaccines will be given before your procedure to help prevent infections once your spleen is removed
It is possible to live without a pancreas. However, once the entire pancreas is removed, your body won’t be able to make pancreatic juices or insulin anymore. After surgery, you will need to test your blood glucose levels, give yourself insulin injections and take other steps to keep your blood glucose levels normal. You will also need to take pancreatic enzyme pills with food to aid in digestion.
Enucleation (removal of just the tumor)
Sometimes if an endocrine tumor is small, just the tumor itself is removed. This procedure is mostly used to remove noncancerous tumors and can be done with a traditional open surgical approach or minimally invasively with a laparoscopic approach. The type of surgical technique your doctor recommends will depend on various factors, including the anatomical location of the tumor.
Appleby procedure (removal of the tail end of pancreas and arteries)
This type of open surgery is typically chosen for patients with very advanced cancers, where a resection has not been performed. It includes removing the tumor from the tail end of the pancreas (distal pancreatectomy), as well as removing affected celiac or hepatic arteries.
Staging laparoscopy (used less frequently)
Since the stage of pancreatic cancer may not always show up accurately on imaging tests, sometimes surgeons perform a staging laparoscopy to determine the extent of the cancer and if it can be removed.
For this procedure, a few small incisions will be made in the abdomen using a small instrument with a video camera. Your surgeon will look at the pancreas and take biopsy samples to learn how far the cancer has spread.
Palliation therapy (procedures for symptom management)
Palliation may be performed by your gastroenterologist if the cancer has spread too far to be removed completely. These types of procedures may be necessary to relieve and prevent symptoms, or to prevent certain complications, like jaundice (yellowing of the skin) or a blocked intestine.
We offer various palliative procedures, including:
Stent placement is a common approach to relieving a blocked bile duct. The procedure does not actually involve surgery. Instead, an endoscope goes through the mouth and the stent (small tube) is inserted inside the duct to keep it open. A bile duct stent can also help relieve jaundice before surgery.
Larger stents may also be used to keep parts of the small intestine open, if they are in danger of being blocked by the cancer. These are called duodenal (intestinal) stents.
Double bypass (gastrojejunostomy and choledochojejunostomy)
A double bypass is another option for relieving a blocked bile duct, often recommended before a stent placement. It reroutes the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas. Performed as a traditional open surgery, this procedure typically requires an incision in the abdomen.
Surgery for precancerous growths in the pancreas
Some growths in the pancreas are noncancerous, while others might become cancer over time if left untreated. It’s important to closely monitor these growths with your doctor to determine if you are at risk of getting pancreatic cancer and if preventative surgical treatment is necessary.
Precancerous growths include:
- Intraductal papillary mucinous neoplasms – Common, noncancerous tumors that grow in the pancreatic ducts. These tumors have cysts filled with a jelly-like substance called mucin. Over time, they sometimes become cancer if certain changes take place, such as increased growth and size, which is why they require constant surveillance.
- Mucinous cystic neoplasms – Slow-growing tumors. Like intraductal papillary mucinous neoplasms, these tumors also have mucin and almost always occur in women. While they are not cancerous, some can progress to cancer over time, so constant surveillance is required to monitor any changes in size and length.
- Solid pseudopapillary neoplasms – Rare, slow-growing tumors that almost always develop in women. Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery.
- Pancreatic neuroendocrine tumors – Tumors that may be cancerous or noncancerous. While they tend to grow slower than more common pancreatic cancers, surgery may still be recommended based upon size and overall risk.