• Surgical Procedures for Pancreatic Cancer

    The primary treatment for pancreatic cancer is surgery. The goal of treatment is to remove as much of the cancer as possible, while preserving the pancreas and its function. The type of surgery depends on the stage, the type of surgery needed, and overall health. When the pancreas is removed, the body can no longer produce insulin to control blood glucose levels. To treat diabetes, people without a pancreas must rely on insulin shots. To overcome the loss of digestive enzyme production, an enzyme pill is taken with meals to help the body digest foods (like fats).
    Pancreatic surgeries are long and difficult procedures that often have postoperative complications. It is important to seek out an experienced surgeon and hospital for these procedures.
    Depression is a common symptom of pancreatic cancer. During a hospital stay, psychotherapy may be part of the treatment plan.

    Surgery for Resectable and Borderline Resectable Pancreatic Cancer

    Curative surgery aims to remove as much tumor as possible, in the hopes of curing the cancer. A resectable or borderline resectable stage is most likely able to be cured with surgery.
    The type of surgery depends on the location and extent of the tumor.
    Procedures for resectable and borderline resectable pancreatic cancer include:
    Pancreaticoduodenectomy (Whipple Procedure)
    A Whipple procedure is the most common surgery, but is also very complex. This is an extremely extensive operation that involves removing the head and body of the pancreas, either all of the stomach or the lower part of the stomach, the first and second sections of the small intestine (duodenum and jejunum), surrounding lymph nodes, the gallbladder, and common bile duct. The remaining parts of the stomach and small intestine are attached together so food can pass through the digestive system.
    Pancreatectomy
    Pancreatectomy may result in removing the tail of the pancreas or the entire organ (total). The spleen, a nearby organ, is also removed during a distal pancreatectomy. This procedure is not usually done for ductal carcinomas (most common type), but may be more useful for other types of pancreatic cancer.
    A total pancreatectomy involves removing the pancreas, gallbladder, spleen, lymph nodes, and parts of the small intestine and stomach.
    In addition, it is possible to live without a spleen, but not having one makes it harder for the body to fight infection. Extra protection against some infections can be attained with vaccines and lifestyle changes.
    Nutritional support may be needed after pancreatic surgery. The type of support depends on the extent of the surgery that was done.
    Nutritional support may be needed after pancreatic surgery. The type of support depends on the extent of the surgery that was done.

    Palliative Surgery for Unresectable Pancreatic Cancer

    Some procedures can be done to relieve complications and improve quality of life. As cancer grows, it affects the body's ability to work properly. Most of these procedures are done during an endoscopy.
    • Stent—A stent can be used to open an area that may be blocked by a tumor or a collapsed duct. A biliary stent is used in the common bile duct and an enteral stent is used in the stomach and/or small intestine.
    • Biliary bypass—An opening is created between the gallbladder and part of the small intestine. This allows bile to flow around the pancreas and into the small intestine.
    • Gastric bypass—If the stomach is blocked and food cannot move through the digestive system normally, the stomach can be directly connected to the small intestine.

    References

    De La Cruz MD, Young AP, Ruffin MT. Diagnosis and management of pancreatic cancer. Am Fam Physician. 2014;89(8):626-632.

    Pancreatic cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114527/Pancreatic-cancer. Updated July 6, 2016. Accessed March 24, 2017.

    Pancreatic cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gi-tract/pancreatic-cancer. Updated January 2017. Accessed March 24, 2017.

    Surgery for pancreatic cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/pancreatic-cancer/treating/surgery.html. Updated May 31, 2016. Accessed March 24, 2017.

    Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/%5F162. Updaed December 23, 2016. Accessed March 24, 2017.

    9/18/2007 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114527/Pancreatic-cancer: Küchler T, Bestmann B, Rappat S, Henne-Bruns D, Wood-Dauphinee S. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol. 2007;25(19):2702-2708.

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