Cooperman, Steele, Wayne M.D (Biliary and Pancreatic Surgery of New York)
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Biliary and Pancreatic Surgery of New York - (212) 604-6822
 
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Oesophageal Cancer :: Liver Cancer :: Pancreatic Cancer

Pancreatic Cancer

Specializing in diseases of the pancreas, bile ducts, gallbladder, and liver.

  • Whipple's operation (also called Kausch-Whipple's or pancreatoduodenectomy)
  • Total pancreatectomy
  • Distal pancreatectomy
If your cancer has spread then your surgeon will not offer these operations because they will not cure you. Unfortunately, this is true in most cases. Only about 1 in 5 patients have cancer that can possibly be cured with surgery. Even then, sadly most patients who do have surgery will not actually be cured. The cancer is very likely to come back in many cases.

Suggestion

These are highly specialised operations. The best results come from specialist centers. Surgeons that work in specialist centers do most of these operations and so are better at doing them.

Whipple's operation

This is an operation to take out the head of the pancreas. Whipple's involves removing:

  • Part of your pancreas
  • Your duodenum (the first part of your small bowel)
  • Part of your stomach
  • Your gall bladder and part of your bile duct
Whipple's before diagram
The diagram below shows what your surgeon removes.

This diagram shows how the surgeon reconstructs the drainage for the stomach, bile duct, and pancreas after the removal of the head of the Pancreas, Duodenum, Distal Stomah.

Whipple's after diagram
This diagram shows you what the surgeon takes away.

Total pancreatectomy

Involves removing:

  • The whole pancreas
  • Your duodenum
  • Part of the stomach
  • The gall bladder and part of your bile duct
  • The spleen
  • Many of the surrounding lymph nodes
Total pancreatectomy before diagram

And this diagram shows you how the surgeon repairs what is left behind.

Total pancreatectomy after diagram

This operation is not done very often. When results have been compared, it has not been any more successful than a Whipple's operation. As this operation is harder to recover from, pancreatic specialists opt for Whipple's instead.

To have a total pancreatectomy you must be fit enough to survive such major surgery and a long anaesthetic. You must also be fit enough to cope with getting over the operation. Losing your pancreas will affect your digestive system. You will also be diabetic. Losing your spleen increases your risk of infection. And can affect your blood clotting.

After the surgery you will have to:

  • Take enzymes to help you digest food
  • Have regular blood sugar checks and insulin injections
  • Have vaccinations and possibly take antibiotics for the rest of your life to prevent infections (if your spleen has been removed)

It will take time to get back to eating even near normally after this type of surgery. You may have problems absorbing food and with diarrhoea.

Distal pancreatectomy

This means taking out the other part of the pancreas and leaving the head. Surgeons use it to try to cure cancer of the body and tail of the pancreas. Usually your surgeon will take out your spleen as well, because the tail of the pancreas is right next to it.

Unfortunately, distal pancreatectomy is not suitable for everyone. Most people have cancer that has spread and is not operable. As few as 1 in 20 patients (5%) with pancreatic cancer of the body or tail can have this surgery.

As with Whipple's, you will have part of your pancreas left behind. So you should not need enzymes or insulin. But as with all the other surgery to cure pancreatic cancer, it involves a major operation and long anaesthetic.

Complications of major pancreatic surgery

A complication is something that happens after surgery that makes your recovery more difficult. Lung infection or blood clots are both common complications after any surgery.

All these operations are very major surgery and there are risks attached to them. But they are done to try to cure your cancer so you may feel it is worth taking some risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to. It is important that your family are given the chance to talk things through with the surgeon as well.

Complications are most likely with the biggest operations - total pancreatectomy and Kausch-Whipple's. The complication rate is lowest in specialist centers where the surgeons are more practised at doing this difficult surgery.

Overall, about 4 out of every 10 patients having the major operations have one or more complications. The commonest complications are

  • Internal infection or abscess
  • Fluid collection
  • Bleeding
  • Fistula
  • Lung infection
  • Heart problems

Read on for more about all these complications.

Infection can develop because there is blood or tissue fluid collecting internally around the operation site. Or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. This is usually done by putting in a needle or drainage tube. The needle or tube is guided into place by CT Scan or ultrasound.

You may have bleeding straight after your operation because a blood vessel tie is leaking. Or because your blood is not clotting properly. Bleeding in the few days following surgery can happen because there is infection or a fistula forming. How bleeding is treated depends on what is causing it.

'Fistula' means opening. In this case, it means that part of the internal sutured to the digestive system has come apart or broken down. Therefore some of the digestive juices are able to get into your abdomen. About 1 in 10 patients having major pancreatic surgery will have a fistula. If you get one, you will have a wound drain put in and have drugs to control the inflammation. The drains will be left in until the fistula dries up. The fistula then heals on its own. Sometimes, the surgeon has to operate again to repair the leak.

Lung infection is a common complication of many operations. It happens because you are not moving around enough, or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help to prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving.

You will have had heart tests before your surgery, but these are major operations and do increase the strain on your heart. Some people do develop heart problems after surgery that they did not have before it.

Complications after surgery can be very serious. They are becoming less common as surgeons get better at deciding who is likely to make a good recovery from this type of surgery. And as more of these major operations are done in specialist centers. But even so, as many as 5% who have the most major surgery may die directly as a result of complications after their operation. The number of deaths are less at centers who perform this operation routinely.

Cooperman, Steele, Pacholka, Wayne M.D (Biliary and Pancreatic Surgery of New York) - Multimedia Patient Education
 

© Cooperman, Steele, Wayne M.D., Biliary and Pancreatic Surgery of New York

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