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. Taking out only part of the cancer generally does not improve treatment results for patients, and the surgery is complex with a lengthy recovery.
- If imaging studies, such as computed tomography (CT) scans, suggest that surgeons will be able to remove all of your cancer, your team may recommend surgery.
- If surgery is not a good option for you, you have other options, such as chemotherapy and radiation therapy.
Surgery for SCCA patients with pancreatic cancer or pancreatic NETs is performed at University of Washington Medical Center (UWMC) by expert surgeons specially trained to do your type of operation.
- Our surgeons participate in the American College of Surgeons National Surgical Quality Improvement Program for pancreatic surgery to track and improve outcomes.
- After your surgery, your care team at UWMC follows evidence-based guidelines to enhance your recovery (“early-recovery after surgery” protocols).
The main surgeries for pancreatic cancer or pancreatic NETs are:
- Whipple procedure (pancreatoduodenectomy)
- Distal pancreatectomy
- Total pancreatectomy
- Central pancreatectomy
In this complex operation, surgeons remove part of your stomach, part of your small intestine (the duodenum and part of the jejunum), your bile duct that's outside your liver, your gallbladder and the wide end of your pancreas near the center of your abdomen (called the head, neck and uncinate process).
Then they pull your remaining jejunum up and connect your remaining bile duct, pancreas and stomach to it.
- 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 recommends that pancreatic resections should be done at institutions that perform a large number of them annually (at least 15-20).2
- We have two surgeons at UWMC who perform pancreatic resections. They typically perform 70-90 of these procedures each year.
If you have pancreatic 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 liver surgery is not right for you, your team will offer other options to treat liver metastases.
If cancer is in the tail of your pancreas (the narrow end, near your side) and not in the head, your surgeon may remove the tail and body of your pancreas. Whenever possible, our surgeons try to leave your spleen, but they may have to remove it in order to get all the nearby lymph nodes.
In some situations, the entire pancreas is removed along with surrounding structures. Your surgeon may recommend this if your tumor is large, it involves almost your whole pancreas or it spans the central area from the neck to the body of the pancreas.
This approach may also be used for people with familial pancreatic cancer. They might have a Whipple procedure or distal pancreatectomy first. Then if follow-up care shows a lesion has developed in their remaining pancreas, the rest of the gland may be removed.
For pancreatic NETs, surgeons may be able to remove tissue from the center of your pancreas, leaving the rest. This is not an option for pancreatic ductal adenocarcinoma because of the likelihood of cancer spreading to your lymph nodes.
This is surgery to remove only pancreatic NETs (not exocrine pancreatic cancer), leaving the rest of your 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, your surgeon may need to remove some other structures in the area, like part of your small intestine and nearby lymph nodes.
Minimally invasive surgery
Our surgeons perform minimally invasive laparoscopic surgery (through small "keyhole" incisions) whenever possible. Benefits can include less pain, less narcotic pain medicine, less time in the hospital, fewer complications and better overall recovery.
Open surgery (through a longer incision) is necessary in some situations, such as when a pancreatic tumor involves nearby blood vessels.
Your surgeon may perform laparoscopic surgery using the robotic da Vinci Surgical System. With da Vinci, your surgeon sits at a console and uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments. The console gives your surgeon a 3D view (not a flat view, like on a monitor screen). Da Vinci allows your surgeon to make very precise, complex motions (more than traditional laparoscopic instruments do), and the ideal ergonomics help prevent fatigue during long operations.
1 Pancreatic Cancer Surgery, American Cancer Society, 2018
2 NCCN Guidelines: Pancreatic Adenocarcinoma, National Comprehensive Cancer Network, 2018