There are many reasons to operate on the pancreas and these vary depending on the type of problem and its location. The majority of patients with pancreatic cancer are not suitable for surgery because of extensive local invasion or distant secondaries. And sometimes patients are just not fit enough for this major surgery.
Occasionally preoperative chemotherapy and/or radiotherapy will be offered to patients if it is thought that this might increase the chance of removing the pancreatic cancer.
AWhipple’s procedure or pancreatoduodenectomy is usually performed for cancer in the head of the pancreas, duodenum, or bile duct. This involves removing a block of tissue as a unit (head of pancreas, duodenum, bile duct, gallbladder, some stomach, and regional lymph nodes). It is done this way because it is safest to do so. The pancreas is draped across some large arteries and veins, and if these are invaded by the cancer it may not be possible to remove the cancer. This means that the first phase of the operation is a trial removal, where a careful dissection of the tissues is carried out. If the cancer can be removed, and it usually is, then the second phase of the operation is the reconstruction using small intestine. Each phase can take 2-3 hours.
A total pancreatectomy is sometimes required for multiple cysts of the pancreas. This will render the patient dependent on pancreatic enzymes (capsules) and insulin (injections).
There a general risks of these operations for which precautions are taken. The risk that is uppermost in the surgeons mind is a potential leak from the join (anastomosis) between the pancreas and the small intestine. The risks of this are increased with a soft fatty pancreas and if the pancreatic duct is very small. The risks are decreased by expert surgery, but it cannot be decreased to zero. A leak is usually managed without the need for further surgery.
The patient may in hospital for 7 to 10 days and will require a month or two of convalescence. Postoperative chemotherapy will often be required for those with a pancreatic cancer that has been removed.
A distalpancreatectomy is performed for cancer in the body or tail of the pancreas, and includes removing the spleen and adjacent lymph nodes.