Removal of a Tumor in the Middle or End of the Pancreas

Figure 1. The pancreas and spleen

This guide will help you prepare for your pancreas surgery at Memorial Sloan Kettering Cancer Center (MSK).

The pancreas makes hormones that control blood sugar. It also makes enzymes to help digestion, especially of fat.

The spleen makes white blood cells that help the body fight infections. The spleen also filters blood, stores blood cells, and destroys old blood cells.

During your pancreas surgery, a tumor from your pancreas will be removed. Your surgeon will explore your pancreas. He or she will decide how much of the area needs to be removed.

  • If a tumor from the body or tail of the pancreas is removed, it is called a distal pancreatectomy (see Figure 2).
  • If your spleen is removed, it is called a splenectomy.

Your surgery will take 2 to 5 hours. Most patients stay in the hospital 5 to 6 nights after their surgery.

Figure 2. The pancreas

Before Your Surgery

During your presurgical testing (PST) appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medicine to sleep during surgery). You can eat and take your usual medications the day of your PST appointment. During your appointment, your nurse practitioner will review your medical and surgical history with you, including your medications. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers. It is very helpful if you bring the following with you to your PST appointment:

  • Medication list
  • Reports of any tests done outside of MSKCC, such as a cardiac stress test, echocardiogram, or carotid doppler study
  • The name and telephone number of your doctor(s)

You will be given a card called Getting Ready for Surgery. This resource provides important information on how to prepare for your procedure.

If your surgeon is planning to remove your spleen during your pancreas surgery, you will get a vaccine to help strengthen your body’s ability to fight disease. The vaccine will usually be given before surgery. You may also have to get the vaccine 5 years after your surgery.

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After Your Surgery

When you wake up after your procedure, you will be in the Post-Anesthesia Care Unit (PACU).

You will have an oxygen mask covering your nose and mouth. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have a Foley® catheter in your bladder to monitor the amount of urine you are making. You will also have compression boots on your lower legs to help your circulation.

You may have a plastic drain in place when you leave the hospital. This is inserted in your stomach area to drain extra fluid. The drain is usually removed 6 weeks after your surgery. Your nurse will teach you how to care for it.

Once you are fully awake, your oxygen mask will be taken off. You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them. Depending on the procedure you had, you may stay in the PACU overnight.

Once your anesthesia has worn off, you will be taken to your hospital room. There, your nurse will show you how to recover from your surgery. Below are 2 examples of ways you can help yourself recover safely.

  • It is important to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs.
  • Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. When using your incentive spirometer or doing other breathing exercises, it may help to splint your incision (surgical cut). To do this, hold a pillow or blanket against the incision sites.

You will have some pain after your procedure. Your doctor and nurse will ask you about your pain often. You will be given medication to treat your pain as needed. You will be able to give yourself pain medicine by using a patient-controlled analgesia (PCA) device. You will get a fact card called Intravenous Patient-Controlled Analgesia (IV PCA) to review. If your pain is not relieved, please tell your doctor or nurse.

You can begin to take ice chips and clear liquids several hours after your surgery. It is normal to not be as hungry as you were before your surgery. A dietitian will meet with you and help you plan your diet before you are discharged. If you need to reach a dietitian after you go home, call 212-639-7312.

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Commonly asked questions

Here are some commonly asked questions patients ask after surgery. Ask your doctor or nurse to explain anything you don’t understand or if you have additional questions.

Will I have pain?

You will be given a prescription for a mild pain medication before you go home. You may want to take extra strength acetaminophen (extra strength Tylenol®) instead. Ask your nurse or doctor when to take other over-the-counter pain medication.

Can I resume my activities?

It is important to resume activity after your surgery. Spread your activities over the course of the day. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed.

Your body is an excellent guide in telling you when you have done too much. When you increase your activity, monitor your body’s reaction. You may find that you have more energy in the morning or the afternoon. Plan your activities for times of the day when you have more energy.

When can I lift heavy objects?

Check with your doctor before you do any heavy lifting. Normally, you should not lift anything over 10 pounds for at least 6 weeks.

When is it safe for me to drive?

Check with your doctor before you begin driving. Normally you should not drive for at least 1 week after your surgery.

When should I see my surgeon?

You should see your surgeon 10 to 14 days after your surgery. Call the office to make the appointment. Your surgeon will check your incision. Your pathology report should be ready and your surgeon will discuss it with you. You will also talk about whether you need more treatment.

Is it normal not to be hungry?

It is normal to be less hungry than usual after your surgery. Eating a balanced diet high in calories and protein is important for healing after surgery. You should limit your fat intake as well as include a good protein source at each meal. For more tips on increasing your calorie and protein intake, ask for the booklet Eating Well During and After Your Cancer Treatment. If you have questions about your diet, ask to see a dietitian.

Is it normal to feel tired?

It is normal to have less energy than usual after your surgery. Recovery time varies with each patient. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is a vital part of your recovery. You will be given a card called Handling Fatigue During and After Cancer Treatment. This resource provides important information on how to handle energy .

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Call Your Doctor or Nurse if You Have

  • Chills or fever of 101°F (38.3° C) or higher
  • Redness or drainage from your incision
  • Any sudden increase in pain or new pain
  • Nausea and vomiting
  • Diarrhea
  • Constipation that is not relieved within two to three days
  • Any new or unexplained symptom
  • Any questions or concerns
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