Surgery
Surgery for pancreatic cancer can be very effective, with low risk of complications, and it is the standard treatment for tumors that can be removed, even in older patients. When performed on patients whose cancer hasn't spread, surgery currently offers the only hope for cure.
Surgery is also an important tool for diagnosis of pancreatic cancers. Advanced techniques such as CT angiography (a view of blood vessels enhanced by computed tomographic techniques) improve physicians' ability to determine the extent of disease and devise the most effective treatment plan for each patient.
Research conducted by surgeons at Memorial Sloan-Kettering showed that pancreatic surgery can be performed in elderly patients with good outcomes comparable to those of younger patients. This study demonstrated that chronological age alone should not be the sole determinant when deciding upon surgery in patients over the age of 70. [Ann Surg 222:426,1995]
The most common type of surgery is the Whipple procedure (also known as a pancreatoduodenectomy). This procedure removes the right-most section, or "head," of the pancreas -- and sometimes more of the gland -- as well as the gallbladder, part of the stomach, the lower half of the bile duct, and part of the small intestine. The cut surfaces of the stomach, bile duct, and remaining pancreas are then joined to the small intestine. After this operation, the patient can generally produce adequate amounts of insulin and digestive enzymes.
Other, less commonly used, procedures include total pancreatectomy (in which the whole pancreas is removed, along with the gallbladder, part of the stomach, part of the small intestine, the bile duct, the spleen, and nearby lymph nodes) and distal pancreatectomy (in which the body and tail of the pancreas are removed).
Surgery for pancreatic cancer is a major operation. The surgeon may remove all or part of the pancreas, which may make it hard to digest foods. Nutrition counseling and supportive care are essential elements of comprehensive treatment of pancreatic cancer. Our doctors' expertise and extensive experience in pancreatic cancer surgery has resulted in an extremely low mortality rate compared to that of most hospitals [Ann Surg Oncol 9:847,2002].
One of the largest referral programs in the nation, Memorial Sloan-Kettering is currently undertaking a large study of more than 2,000 operations for pancreatic cancer, including both standard surgeries and laparoscopic procedures, to identify best practices and provide a benchmark for future innovations in surgical technique.
Even after successful surgery, pancreatic cancer can sometimes spread (metastasize), so most treatment plans include additional therapies such as radiation therapy, chemotherapy, and biologic approaches.