Pancreatic Cancer Surgery

This is the largest operation performed on the abdomen, and the form it takes depends entirely on which part of the pancreas is involved.

Disease in the head of the pancreas requires a Whipple operation. The pancreas sits wrapped around the duodenum and shares its blood supply with it, so the head of the pancreas, the duodenum, the gallbladder, the lower bile duct and sometimes part of the stomach all come out together. Three separate joins are then made to reconnect the pancreas, the bile duct and the stomach to the small intestine. Disease in the body or tail allows a smaller operation, removing the tail of the pancreas and usually the spleen alongside it.

Whether the operation is possible at all is a question of the great blood vessels. The pancreas lies against the arteries and veins supplying the entire intestine, and how far disease has spread around them decides whether it can be separated from them safely. That judgement is made from a specific pancreatic protocol CT scan and reviewed by a multidisciplinary team. Where the answer is borderline, chemotherapy is given first and the scan repeated. Outcomes for these operations are measurably better in centres that perform them regularly, and it is reasonable to ask how often yours does.

You are admitted two or three days beforehand for final assessment, nutrition and, if you are jaundiced, sometimes a stent to drain the bile duct first. Diabetes and nutritional state are optimised before you go to theatre.

The operation is under a general anaesthetic. A Whipple takes five to eight hours, a tail resection two to four. Most are done open, through a cut across the upper abdomen, and selected cases by keyhole or robot. An epidural is standard for pain relief.

You wake in intensive care and stay there for one to three days. You will have drains next to the pancreatic join, a urinary catheter, and often a fine feeding tube into the small bowel. The drains stay while the fluid in them is tested for pancreatic enzyme, because that test is how a leak is detected early. Fluids by mouth start within a few days and diet builds slowly. A stay of ten to fourteen days is normal, and longer is common.

Plan for two to three months before you feel substantially recovered, and accept that the first month is dominated by tiredness and a poor appetite.

Eating restarts small and often. The pancreas makes the enzymes that digest fat, and after this operation there is less of it, so most people need pancreatic enzyme capsules with every meal and snack for life. Taken correctly, with the first mouthful and through the meal, they stop the pale, greasy, floating stool and the weight loss that follow undigested fat. A dietitian will set the dose with you and it is usually increased before it is right.

Diabetes is common afterwards, either newly or worse than before, and your blood sugar will be monitored and treated. If your spleen was removed you need specific vaccinations and, often, long-term antibiotics, because the spleen fights particular bacteria and you are at lifelong risk of sudden severe infection without it; you will be given a card explaining this. No lifting for eight weeks, driving at four to six weeks, work at two to three months. Chemotherapy, where it is planned, restarts around eight to twelve weeks.