This page was reviewed under our medical and editorial policy by
Chukwuemeka Obiora, MD, Surgical Oncologist
This page was reviewed on April 7, 2023.
Two general surgical approaches are used for pancreatic cancer. One is designed to remove the entire tumor, also referred to as potentially curative surgery. The other is called palliative surgery, and its aim is to ease pancreatic cancer symptoms rather than treating the cancer itself.
An expert care team helps determine which approach to take after tests and exams are performed to diagnose and stage pancreatic cancer. Removing only part of the cancer does not improve outcomes for pancreatic cancer, so if the tumor is too large or advanced to be completely removed, the care team may recommend palliative surgery. The goal of palliative surgery is to relieve discomfort and prevent the cancer from causing more problems. For example, palliative surgery may be used to remove cancerous tissue to clear a blockage in the bile ducts or intestines.
Surgical resection may be an option when pancreatic cancer is at an early stage and the tumor is small and confined to the pancreas. According to the National Cancer Institute (NCI), only about 20 percent of patients are diagnosed at an earlier stage and are candidates for surgical treatments.
While surgery may improve outcomes for pancreatic cancer, the chances of the patient having no evidence of disease after treatment are still low. If the surgeon completely removes the tumor, an estimated 18 percent to 24 percent of patients live five years or more, according to the NCI.
Many surgeries may still leave behind some cancer cells, which may grow and spread. Similarly, small bits of cancer may break off from the primary tumor before surgery and spread elsewhere in the body without being detected. Other treatments, such as chemotherapy, may be used in combination with surgery to help destroy these metastatic cells in the hopes of improving outcomes.
The Whipple procedure is often used when pancreatic cancer is located in the head of the pancreas. The pancreas looks a bit like a sweet potato, with a rounder, bigger head and neck that narrows into the body and finishes with a pointy tail. The procedure involves removing the head and, in some cases, the body of the pancreas.
Other organs and tissues may also be removed during the Whipple procedure, also called a pancreatoduodenectomy. These may include lymph nodes, the gallbladder and parts of the bile duct, small intestine and stomach. In these cases, the surgeon stitches together the remaining organs to maintain the flow of the digestive system.
The procedure is highly technical, and patients may develop complications, including:
After a Whipple procedure, patients may require treatments to help restore bodily function once performed by the pancreas, depending on how much of the organ is removed. For example, enzyme pills may be recommended to aid digestion if the pancreas no longer produces enough digestive enzymes.
The procedure itself is risky. Between 1 percent and 15 percent of patients die from complications after a Whipple procedure, according to the American Cancer Society (ACS). However, the high end of this range only occurs when it’s performed by inexperienced surgeons in small hospitals. When performed by seasoned surgeons in cancer centers, that number drops to less than 5 percent, according to ACS.
This type of surgery may be used to treat pancreatic cancer if the tumor is found in the tail of the pancreas and tests suggest the cancer may be completely removed with surgery. However, tumors in this part of the pancreas are often too advanced for surgery by the time they’re diagnosed.
A distal pancreatectomy involves removing the tail of the pancreas and, sometimes, the spleen and main section of the pancreas. Potential complications of distal pancreatectomy are similar to those of a Whipple procedure, including bleeding, leakage of fluids and digestion difficulties. Since the procedure typically involves removing the spleen, which helps the immune system fight off germs, patients may be more vulnerable to infection after the surgery. Doctors may advise getting vaccinations to protect against certain infections before undergoing a distal pancreatectomy.
A total pancreatectomy involves removing the gallbladder, spleen and some of the stomach and small intestine, in addition to the entire pancreas. A total pancreatectomy is rarely the recommended option because it hasn’t been shown to greatly improve outcomes, and it often leads to more significant side effects and post-operative complications than other procedures.
Patients may be able to live without a pancreas, but the body experiences significant changes. After a total pancreatectomy, patients need to manage these conditions listed below.
Diabetes: The pancreas regulates blood sugar levels by producing insulin. After the pancreas is removed, patients develop high blood sugar and diabetes and require insulin.
Digestive issues: The pancreas makes enzymes necessary to break down foods. Without the pancreas, patients need to take pills to replace these enzymes so they can digest food.
Risk of infections if the spleen is removed: The spleen helps the immune system work by producing white blood cells, so if it’s removed, the body’s defenses will be weakened. Patients may need to get extra vaccinations or take antibiotics to protect themselves against illness.
If the cancer is too advanced for surgical treatment, other types of surgery may be recommended to relieve discomfort or prevent tumors from causing complications.
For example, as tumors in the pancreas grow, they often block parts of the digestive system and cause pain and other discomfort. Blockages in the common bile duct are typical with pancreatic cancer and obstruct the flow of bile from the pancreas to the intestines. That causes bile to build up in the body, preventing it from reaching the intestines, where it helps digest food and nutrients. Bile duct obstructions may cause a number of disruptive side effects, including pain, digestive issues and jaundice (yellowing of the skin and eyes).
Palliative surgery may be recommended to help treat conditions like a bile duct obstruction. However, performing surgery to relieve or prevent symptoms also comes with risks. An expert care team helps patients carefully weigh the risks and benefits before undergoing palliative surgery.
Types of palliative surgery for pancreatic cancer include those below.
A pancreatic stent placement is the most commonly used treatment for an obstructed bile duct. The goal is to restart and preserve the flow of bile by placing a small tube, or stent, inside the blocked duct. The stent helps the duct stay open. The procedure is typically performed using an endoscope, a long tube that’s inserted through the throat as part of a procedure called an endoscopic retrograde cholangiopancreatography (ERCP).
With an ERCP, patients are sedated while the endoscope is advanced to the area of the blockage. Then, a colored solution is injected into the bile duct. With tools that relay X-ray images to a monitor, the surgeon sees the exact location of the blockage and where to insert the stent.
Another method is called percutaneous transhepatic cholangiography, or PTC. It involves passing a hollow needle through the abdomen and into the blocked bile duct. The stent is then passed through the needle.
Having a stent placement is usually a relatively simple and safe process. As with all procedures, however, it may pose risks. After a couple of months, a stent may get clogged with bile or become blocked by the cancer growing around it. In some cases, a stent procedure may need to be redone.
Stent placements also come with a risk of infection. Patients will need to monitor symptoms after the procedure and let the doctor know if they have fever or other potential signs of an infection. The doctor may prescribe antibiotics to lower the infection risk.
Bypass surgery for pancreatic cancer has the same goal as a stent placement—to clear a blockage in the digestive system caused by a pancreatic tumor. It may also be used to clear a blockage in the pathway of food from the stomach to the intestine, in a procedure called a gastric bypass, as well as an obstructed bile duct, called a biliary bypass.
For a gastric bypass, the stomach is connected directly to the small intestine to provide a path around a tumor that’s preventing food from exiting the stomach. A biliary bypass involves disconnecting the part of the gallbladder or bile duct just before the blockage and then attaching it to the small intestine.
Bypass surgery is a more invasive procedure than a stent placement and recovery typically takes longer. However, it may offer a longer-lasting solution for blockages than a stent. To perform a bypass surgery, the surgeon typically makes a large incision in the abdomen. Sometimes, the bypass is performed with laparoscopic surgery, which involves making several small incisions around the abdomen and then inserting tools through them to perform the operation.