Low stage pancreatic cancers (stage I and II) can be treated surgically.

By the time most patients with pancreatic cancer are diagnosed, the disease is already in an advanced stage. For this reason, a large majority of patients with pancreatic cancer are not candidates for surgical treatment. Before reviewing the surgical procedures, it is important to emphasize that every patient is unique and every case needs to be discussed in detail with your healthcare providers.

Scientists at Johns Hopkins are making advances in understanding the early stages of this disease, and it is our hope that in the future more cases will be detected earlier, when they are still operable.

John Cameron

When is surgery possible?

Generally if the cancer is localized, surgical treatment, resection or removal of the tumor, can be pursued. This means that the cancer has not spread to involve major blood vessels, lymph nodes far from the pancreas or other organs, such as the liver or lung. These characteristics are determined through various complimentary diagnostic techniques, but most often involves a CAT scan. If the cancer has spread to nearby lymph nodes that are routinely removed during a given surgical procedure, surgery will usually still be possible. Also, recent developments allow surgeons to resect short segments of the portal vein, a major blood vessel that carries blood to the liver.

What excludes surgery as a treatment option?

Generally, if the cancer is found in distant lymph nodes, other organs or blood vessels, surgical resection will not be pursued. If this is the case, the doctors and/or nurses will discuss possible medical treatments and/or palliative procedures. Surgery may still be considered to alleviate some symptoms and make the patient more comfortable (see bypass) but not as a curative measure.

What types of surgical procedures are performed to treat pancreatic cancer?

This depends where the tumor is located within the pancreas.

Cancer in the Head, Neck or Uncinate Process of the Pancreas   

The Whipple Procedure

Also called a pancreaticoduodenectomy, which is generally the removal of the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas. This operation was first described by Dr. Alan O. Whipple of New York Memorial Hospital (now called Memorial Sloan-Kettering). Since that time, there have been many modifications and improvements of the procedure.

There are several variations of "the Whipple" currently practiced:

  • Standard Whipple with lymph node dissection
  • Radical Whipple with lymph node dissection
  • Pylorus Preserving - preserves the pylorus (where the stomach empties into the duodenum)
  • Classic - includes removal of 40% of the stomach

In selected cases, Dr. Jin He at Johns Hopkins performs robotic Whipple resections.

Whipple procedure illustrations

Cancer in the Body or Tail of the Pancreas   

Distal Pancreatectomy and Splenectomy

Due to the position of the body and tail of the pancreas within the anatomy, tumors in this area may develop for some time before causing symptoms, such as pain or jaundice. Unfortunately, once these symptoms appear the cancer is usually at an advanced stage, often with evidence metastases. For this reason most patients with tumors of the body or tail are not operable.

If the tumor is operable, a laparoscopic pancreas surgery and splenectomy is often performed. This is the removal of the left portion of the pancreas and the spleen. Recently, robotic surgery emerged as an alternative to laparoscopic surgery, overcoming the intrinsic limitations of laparoscopy. In some procedures, such as radical prostatectomy and hysterectomy, robotic surgery has demonstrated advantages over laparoscopy.

Robotic Pancreas Surgery

How can palliative surgery improve quality of life?

A palliative surgical procedure to alleviate jaundice, nausea and vomiting for patients with advanced tumors in the head of the pancreas. The double bypass involves a bypass to the bile duct and a bypass to the stomach. Often a celiac nerve block is also performed.

Celiac Nerve Block- Can be done during a surgical procedure or as a separate non-surgical procedure. This improves tumor-associated pain and may reduce the need to use pain medications.