Pancreatic Cancer

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Surgery

Surgery is the only treatment with the potential to cure cancer that starts in the pancreas—but only if all the cancer can be removed. Your cancer care team may recommend surgery if imaging studies, such as computed tomography (CT) scans, suggest that surgeons will be able to remove all of your cancer.

Dr. Pillarisetty discusses minimally invasive surgical techniques for pancreatic cancer

Taking out only part of the cancer generally does not improve treatment results for patients, and the surgery is complex with a lengthy recovery. So if imaging shows that your cancer cannot be removed completely, your doctors are not likely to recommend surgery. In this case, you have other options, such as radiation therapy and chemotherapy.

Surgery for Seattle Cancer Care Alliance (SCCA) patients with exocrine pancreatic cancer or pancreatic NETs is performed by expert surgeons at University of Washington Medical Center (UWMC). If you need surgery, it will be done by a surgeon who is specially trained to do your type of operation. Your surgeon will work closely with the other members of your health care team.

The Whipple Procedure

Also called a pancreaticoduodenectomy, the Whipple Procedure is a complex operation in which surgeons remove the head of the pancreas (the wide end, near the center of your abdomen), sometimes the body of the pancreas (the middle part), part of the stomach, part of the small intestine, the gallbladder, and lymph nodes nearby. They also remove part of common bile duct (which connects the liver and pancreas to the small intestine); then they connect the remaining bile duct to the small intestine so bile can flow from the liver to the intestine.

Experience matters

According to the American Cancer Society, the risk of complications from this operation is significantly lower when it’s performed at an experienced cancer center by a surgeon who does the procedure frequently.1,2

The National Comprehensive Cancer Network (NCCN) recommends that pancreatic resections should be done at institutions that perform a large number (>15-20) of pancreatic resections annually.2 Surgeons at UWMC typically do more than 30 resections each year. In 2013, they performed 69 of these operations.

A common place where pancreatic NETs spread (metastasize) is the liver. If you have NETs that have spread to your liver, your team may recommend removing tumors from your liver either before or at the same time as the Whipple procedure, if they believe this may improve your results. If liver surgery is not right for you, your team will offer other options to treat liver metastases.

Distal Pancreatectomy

If cancer is in the tail of the pancreas (the narrow end, near your side) and not in the head, the surgeon may remove the tail, the body of the pancreas, and the spleen. In some situations when cancer is present throughout the pancreas, the entire pancreas can be removed (total pancreatectomy) along with surrounding structures.

Enucleation

This is surgery to remove only pancreatic NETs, leaving the rest of the pancreas in place. It may be an option if you have small NETs in just one part of your pancreas. Based on the location of the NETs and whether they are likely to have spread, the surgeon may need to remove some other structures in the area, like part of the small intestine and nearby lymph nodes.

Other Operations for Pancreatic NETs

If you have NETs that secrete hormones, as some do, other operations may help treat the effects of your cancer. For example, a type of NET called gastrinoma may secrete large amounts of the hormone gastrin. Gastrin triggers the release of acid in the stomach. If other treatments, like medication, aren’t enough to decrease the acid, surgery can be done to cut the vagus nerve, which controls the cells that make the acid. Your team at SCCA will offer you options like this if they might help reduce your symptoms and improve your quality of life.

1Pancreatic Cancer Surgery, American Cancer Society, 2013
2NCCN Guidelines: Pancreatic Adenocarcinoma, National Comprehensive Cancer Network, 2012