Pancreas Surgery

Smilow Cancer Hospital is a regional referral center for patients in need of surgery for pancreatic cancer. Several operative procedures exist and the choice of surgery is tailored to the individual patient after reviewing the details of the tumor. The Whipple procedure is the most frequent operation and is used for tumors in the pancreatic head. Distal pancreatectomy, often done laparoscopically, is used for tumors of the pancreatic body and tail, and rarely, there is a need for a total pancreatectomy. Our surgeons, members of the Yale Surgical Oncology Program have in excess of 30 years of experience in pancreatic surgery and are the highest volume center for pancreatic surgery in Connecticut, performing approximately 100 pancreatic resections each year. Current operative techniques and careful attention to the postoperative management in and outside of the hospital optimizes the opportunity for our patient’s complete recovery.

Types of Pancreas Cancer Surgery

There are several types of surgery for pancreatic cancer. The type of surgery a patient needs depends on the location of the tumor in pancreas, and how much of the cancer can be removed by the doctor. Following are the main types of surgery.

This surgery is the most common for completely removing tumors from the pancreas. The surgeon removes:

  • The head of the pancreas, which is the wide end
  • Lymph nodes near the bile duct
  • Duodenum, which is part of the small intestine
  • Part of the stomach
  • In some cases, the body of the pancreas, which is the middle section
  • The gallbladder and part of the common bile duct

After this surgery, bile from the liver, any food from the stomach, and digestive juices from the remaining part of the pancreas all enter the small intestine, to allow normal digestion.

This surgery is similar to the Whipple procedure. However, the surgeon does not remove the lower part of the stomach.

Pylorus-preserving pancreaticoduodenectomy: Anatomy of the resected area (a) and reconnected digestive tract with end-to-end pancreaticojejunostomy (b).

Surgeons perform this less often than they perform the Whipple procedure. The surgeon removes:

  • Entire pancreas
  • Distal common bile duct
  • Duodenum, which is part of your small intestine
  • Part of your stomach
  • Spleen
  • Gallbladder, if you still have one

Once the surgeon removes the entire pancreas, the patient won’t be able to make pancreatic juices or insulin. The patient will need to test their blood glucose levels, give themselves insulin injections, and take other steps to keep their blood glucose levels normal. The patient will also need to take pancreatic enzyme pills with food to aid in digestion.

The surgeon will sometimes perform this surgery if the cancer is confined to the tail of the pancreas. For this surgery, the surgeon removes only the tail of the pancreas, which is the thin part, and perhaps part of its body, the middle section. The surgeon also usually removes the spleen of the patient.

The doctor may suggest surgery and other procedures to ease or prevent symptoms associated with pancreatic cancer, but these surgeries are not intended to cure the disease. These procedures may help restore the bile flow of the patient, allow food to leave the stomach into the small intestine, or ease pain. For instance, surgery may relieve a blocked bile duct by bypassing it. Surgery may also relieve a blockage at the outlet of the stomach to the first part of the small intestine (called the duodenum) by bypassing it. This is called bowel-bypass surgery. It doesn’t cure the disease. These are some of the types of palliative surgery:

  • Surgery to redirect the flow of bile directly into the small intestine
  • Surgery to allow the stomach to empty into another portion of the small intestine
  • Injections to block or numb nerves near the pancreas
  • Placing a stent (a small tube) inside the bile duct or duodenum to help keep it open
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