The pancreas is a gland that lies at the back of the upper abdomen, behind the stomach. It is shaped like a tadpole; the rounded head lies attached to the duodenum (a part of the intestine that forms the outlet of the stomach), while the body and tail extend across to the left side. The pancreas produces digestive juices and aids digestion of food. Pancreatic juice and bile mix with food in the intestine and help digestion. The pancreas also produces insulin which controls the level of sugar in the blood. Lack of insulin causes diabetes.
The operation to remove the head of the pancreas is called pancreaticoduodenectomy.
There are two types of Pancreaticoduodenectomy: the Whipple’s procedure and the pylorus preserving pancreaticoduodenectomy (PPPD). Your surgeon will decide on whether to perform a Whipple’s or PPPD operation according to the type of tumour that you have and what is seen during your operation.
In the Whipple operation the head of the pancreas, lower quarter of the stomach, common bile duct, gallbladder, duodenum (first part of the intestines) and surrounding lymph nodes are removed. The remaining pancreas, bile duct and stomach are then rejoined to the small intestine (jejunum). This allows pancreatic juice, bile and food to flow back into the small intestine, so that digestion can proceed normally.
The operation normally takes 4-7 hours.
If the problem is in the tail of the pancreas your surgeon will recommend an operation called distal pancreatectomy (removal of the tail of the pancreas). Occasionally this operation may also require removal of your spleen. This operation can often be performed laparoscopically (keyhole surgery) and this may be offered to you.
Splenectomy is removal of the spleen. The spleen helps the body’s defense against some infections. Without a spleen your immunity to those bacteria is reduced. You will be given the following vaccinations to improve your immunity: Streptococcus pneumoniae, Haemophilus influenzae type B and Neisseria meningitidis. In addition, you will need to take an antibiotic every day (usually penicillin) on a long term basis to help prevent infection.
This operation involves the removal of the whole pancreas. It is essentially a combination of the pancreaticoduodenectomy and the distal pancreatectomy. You will become permanently diabetic following removal of the whole pancreas. You will be given more information about being diabetic and will also see a diabetic specialist nurse.
If your surgery is for suspected cancer, the tests that you have had indicate that the cancer is localised and has not spread. At the time of surgery, your surgeon may find that it is not possible or advisable to remove the growth. Such a situation arises in 1 in 10-15 cases (7-10%). This may be because the tumour has spread to another location like the liver. It could also be because the tumour has grown beyond the pancreas and become fixed to important blood vessels close by. In these circumstances your surgeon will not remove the tumour and may carry out a bypass procedure, so that future blockage of the bile duct or stomach is prevented.
What are the benefits of surgery?
Without surgery, the average survival of patients with pancreatic cancer is less than one year, and very few survive more than 2 years. The operation aims to completely remove the cancerous growth, and give the best chance of curing the problem. The chance of the cancer recurring depends on the type of tumour that you have. A successful operation can improve your chance of cure to 10%- 50%. This will only be accurately known after the operation, when the pathologist examines the removed pancreas. Your surgeon will receive the full pathology report 2-3 weeks after surgery.
What alternative treatments are available?
Chemotherapy may be able to shrink the cancer or delay its growth. If the tumour has not spread, but cannot be removed surgically because it is extending to nearby structures, then you may be advised a combination of chemotherapy and radiotherapy. However, no treatment other than surgery is able to cure this problem.