Operation (general)

The goal of surgery is often to cure the patient (‘curative’). If the surgeon concludes during surgery that curative surgery is not possible, the patient is usually given palliative surgery to relieve pain or to prevent obstruction of the flow of food and/or bile.

Your specialist or doctor will advise you to have the operation performed in a hospital that specializes in pancreatic surgery.

Types of operations

There are several types of curative surgeries for tumors in and around the pancreas. Each of these surgeries involves removing a portion of the pancreas, sometimes the surrounding tissues, with the goal of removing the tumor. The most common surgeries are:

• pancreatic head resection/pancreaticoduodenectomy (Whipple operation).
• pancreatic tail resection/distal pancreatectomy (text in Dutch only).
• total pancreatic resection/total pancreatectomy (text in Dutch only).

Your doctor will discuss with you which surgery you are eligible for. The doctor will also discuss the pros and cons of the surgery with you so that you can make a well-considered decision.
If the tumor can be removed with surgery, you will be advised to undergo chemotherapy after the surgery, and increasingly also before the surgery.

Different methods

In the past, surgery was mainly performed in the form of an ‘open approach’. In this case, surgery is performed through an incision in the abdomen, which ensures that it can get to the tumor easily, however, it results in a large scar. Another form is laparoscopy: ultra-small instrument(s) and a camera are inserted through small holes in the abdomen. The disadvantage is that the surgeon only has a two-dimensional image. Increasingly, surgeries are starting to be performed using a surgical robot. The surgeon then has a three-dimensional image and can work more precisely, which probably means that patients recover more quickly. This approach is currently being investigated.

When am I eligible for surgery?

This depends on the stage of the tumor (see different stages of pancreatic cancer). Because the tumor is often discovered late, surgery is only possible in 15 to 20% of patients. If the tumor cannot be removed, surgery is sometimes performed to relieve the blockage of the bile ducts and/or duodenum. If your condition allows it, advanced age is no objection to surgery.

To be eligible for surgery, the following conditions must be met:

• no metastases elsewhere in the body, for example, the liver.
• the tumor must not have grown too much into important blood vessels that run close to/below the pancreas.
• your general condition must allow for surgery under anesthesia.

Video pancreatic cancer and surgery

Video pancreatic cancer without metastases, which cannot be removed with surgery