Pancreatic Cancer: Surgery

Pictured: William Jarnagin William Jarnagin, Chief of the Hepatopancreatobiliary Service, is part of Memorial Sloan Kettering's multidisciplinary team of experts caring for patients with pancreatic cancer.

Surgeons at Memorial Sloan Kettering are experts in both open and minimally invasive surgical approaches for pancreatic cancer, including complex open surgical procedures, laparoscopic surgery, and robot-assisted surgery. We have also pioneered new innovations that have made pancreatic surgery a safe treatment for more people than ever before.

It has been found that surgeons and hospitals that perform a higher number of pancreatic surgeries give patients better outcomes. At Memorial Sloan Kettering our surgical team performs more than 300 operations for pancreatic cancer each year, making us among the most experienced in the country.

Many patients with pancreatic cancer have tumors that are considered inoperable at the time of diagnosis. Because surgery for pancreatic cancer is a complex procedure, surgeons at Memorial Sloan Kettering avoid recommending surgery or unnecessarily extensive procedures that will have limited benefit to you.

Our multidisciplinary approach to pancreatic cancer care means that our surgeons collaborate with medical oncologists and radiation oncologists before you receive any treatment. In some cases, patients can receive chemotherapy or radiation therapy before surgery to shrink a tumor (called neoadjuvant therapy). This approach can make surgery an option for some patients with otherwise inoperable tumors, and make an operation safer and more effective.

Our pancreatic surgeons have developed new techniques to reduce surgical complications. We are also evaluating new drugs and techniques that can be used during pancreatic surgery to reduce the risk of pancreatic fluid leakage and blood loss.

No matter which surgical procedure or approach you and your doctor choose, our goals are to remove your cancer completely, limit the spread of cancer cells, and preserve your digestive function.

When Surgery Is Performed

When a pancreatic tumor can be removed safely, surgery offers the best opportunity to extend survival, and in some cases, eliminate the cancer.

Pancreatic surgery is considered a highly effective treatment:

  • For people with tumors that are confined within the pancreas and are not invading major blood vessels
  • When a tumor can be removed completely
  • To remove precancerous lesions from the pancreas

Pancreatic surgery leads to similar outcomes in both young and older patients and when used appropriately is considered safe and effective, even in people over age 70.

Types of Pancreatic Surgery

Surgery for pancreatic cancer involves removing all or part of the pancreas and portions of other digestive organs. There are three types of surgery to remove pancreatic tumors. The approach your doctor recommends will depend on how much the cancer has spread, as well as your general health.

In any type of pancreatic surgery, surgeons attempt to remove the entire tumor. Some operations can be performed with minimally invasive techniques such as laparoscopic and robot-assisted surgery.

Surgeons at Memorial Sloan Kettering have expertise in all of these procedures.

Whipple Procedure

The Whipple procedure, also called pancreatoduodenectomy, is the most common type of surgery for pancreatic cancer. This technique is used to remove tumors that are confined to the head (right portion) of the pancreas.

In the Whipple procedure the surgeon removes the head of the pancreas, part of the small intestine, the lower half of the bile duct, the surrounding lymph nodes, the gallbladder, and sometimes part of the stomach. The operation is called a pylorus-preserving Whipple procedure when the stomach is left intact. The stomach, bile duct, and remaining pancreas are then joined to the small intestine so that digestive enzymes can mix with food. Surgeons may also remove part of the portal vein, a blood vessel that allows blood to flow into the liver, when it has been invaded by a pancreatic tumor. Although this procedure is complex, it is safe and effective for many patients.

Distal Pancreatectomy

This procedure is usually performed in patients with exocrine tumors that are confined to the tail of the pancreas. The surgeon removes the tail (left portion), sometimes part of the body of the pancreas, and sometimes the spleen.

Total Pancreatectomy

If your diagnostic tests indicate that the cancer has spread throughout the pancreas, your surgeon may recommend removing the entire organ. This procedure also involves removal of the gallbladder, part of the stomach, part of the small intestine, the lower half of the bile duct, the spleen, and nearby lymph nodes.

Central Pancreatectomy

Occasionally, just the middle of the pancreas is removed, generally for benign tumors or neuroendocrine tumors. In this operation, the remaining left pancreas is attached to the stomach or intestine.

Minimally Invasive Surgical Techniques

Minimally invasive surgery is a surgical procedure that is performed through small incisions in the abdominal wall. It typically results in the least possible harm to organs and surrounding tissue.

Minimally invasive surgery has a number of potential benefits for patients, including fewer complications, less blood loss, a shorter hospital stay, and quicker recovery than conventional open surgery.

Although minimally invasive surgery is not effective for all people with pancreatic cancer, it is an option for some, especially those who need less-extensive surgery. Surgeons at Memorial Sloan Kettering are experts in two types of minimally invasive surgery for pancreatic cancer: laparoscopic surgery and robot-assisted surgery.

Laparoscopic Surgery

In laparoscopic surgery, the surgeon inserts a laparoscope — a thin, lighted tube with a camera on its tip — through a tiny incision. This approach can be used to remove pancreatic cysts, tumors, and all or part of the gland. The laparoscope can also be used to reconstruct the digestive system.

Surgeons at Memorial Sloan Kettering conducted the largest single-institution study comparing laparoscopic surgery to open surgery for performing distal pancreatectomy. Our research showed that laparoscopic approaches can reduce blood loss and length of hospital stay compared with open surgery.1

Robot-Assisted Surgery

Surgeons at Memorial Sloan Kettering also perform a minimally invasive procedure called robot-assisted laparoscopic pancreatic surgery.

Using a sophisticated device called the da Vinci® Surgical System, the surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a magnified three-dimensional image of the pancreas and the surrounding area, allowing the surgeon to view the surgical site in fine anatomical detail. The surgeon uses the controls to move the robotic arms with much finer precision than would be possible with other surgical techniques.

1Jayaraman S, Gonen M, Brennan M, et al. Laparoscopic distal pancreatectomy: evolution of a technique at a single institution. J Am Coll Surg. 2010 Oct; 211(4):503-9.