Pancreatic Cancer Surgery

Pancreatic Cancer Surgery

William Jarnagin, Chief of the Hepatopancreatobiliary Service

William Jarnagin, Chief of the Hepatobiliary Service, is part of MSK’s large team of experts in treating pancreatic cancer.

Surgery for pancreatic cancer is complex. MSK has developed methods that make pancreatic surgery safer for more people. We have among the most experienced  pancreatic cancer surgery teams  in the country. Our surgeons do more than 350 pancreatic cancer operations each year.

This volume is among the highest in New York City and across North America as well. Patients at hospitals that do a higher number of pancreatic surgeries have better treatment results. 

Pancreatic cysts

Surgery is also the best treatment for pancreatic cysts. The surgery methods we use for pancreatic cyst removal are the same as for pancreatic cancer. Most pancreatic cysts are benign (not cancer). But some are precancerous and can turn into pancreatic cancer. 

Learn more: Answers to common questions about pancreatic cancer surgery

There are 2 approaches to surgery for pancreatic cancer.

Curative surgery

There’s a better chance we can cure pancreatic cancer with surgery if the tumor is only in the pancreas. Curative (able to cure) surgery is when there’s a chance surgery will remove all of the tumor and cancer.   

Palliative surgery

Palliative surgery is when surgery can help with the symptoms of cancer and improve your quality of life. It can also help stop symptoms from getting worse. It may stop complications (problems), such as a blocked bile duct. 

Most people learn they have pancreatic cancer after it’s already spread outside the pancreas. It’s either locally advanced disease or metastatic pancreatic cancer. Surgery will not cure pancreatic cancer at this stage.

Sometimes a curative surgery turns into palliative surgery. After your surgeon starts the operation, they decide surgery cannot cure the cancer. Research suggests this happens during 8 to 33 out of every 100 curative surgeries.   

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MSK surgeons are experts in all pancreatic cancer surgery methods: 


Whipple Procedure

The Whipple procedure  is the most common surgery for pancreatic cancer. It’s also called  a pancreatoduodenectomy (PAN-kree-uh-toh-DOO-ah-deh-NEK-toh-mee).

This surgery removes the head of the pancreas and the gall bladder. It also removes the duodenum (first part of the small intestine), and the end of the common bile duct. Sometimes part of the stomach is removed. Your surgeon will reconnect the tissues.

MSK offers 2 types of Whipple surgery:

Traditional open Whipple: Our team does many more open Whipples than other hospitals in the country. The Whipple procedure is a very complex operation. Research shows hospitals that do a high number of these surgeries have fewer complications and better results. 

Robotic Whipple: MSK is one of the few cancer centers to offer robotic Whipples. This procedure is minimally invasive, which means it does less harm to your body.

People who have this surgery:

  • Spend less time spent in surgery and in the hospital.
  • Have better quality of life after the surgery.
  • Have less pain and smaller scars from surgery.      

The robotic Whipple is a newer treatment for pancreatic cancer. It may not be right for everyone. Your MSK care team will talk with you about which surgery method is best for you.  

Read about Chris, who had pancreatic cancer, to learn more about MSK’s Robotic Whipple program. 

Distal Pancreatectomy

A  distal pancreatectomy  (PAN-kree-uh-TEK-toh-mee) is surgery to remove a tumor from the body or tail of the pancreas. It’s usually done when the tumors are only in the tail of the pancreas. This surgery removes the tail, and sometimes part of the body of the pancreas and the spleen. 

Total Pancreatectomy

A total pancreatectomy (PAN-kree-uh-TEK-toh-mee) is surgery to remove all of the pancreas. Because of the location of the pancreas, your surgeon also must remove other organs. This includes the gallbladder. It also includes part of the stomach and the duodenum (the first part of the small intestine). Your surgeon will also remove the lower half of the bile duct, the spleen, and nearby lymph nodes.

Your surgeon will reconnect your stomach and the rest of your common bile duct to your jejunum (the second part of your small intestine). This lets food and bile flow into your small intestines. 

Central Pancreatectomy

A central pancreatectomy (PAN-kree-uh-TEK-toh-mee) removes just the middle of the pancreas. We often use this procedure when the tumor is benign (not cancer). Your surgeon will attach the rest of the pancreas to the stomach or intestine.

Minimally Invasive Surgery for Pancreatic Cancer

We can do some pancreatic cancer surgeries using methods that are minimally invasive. This kind of surgery does less harm to your body because it’s done with small incisions (cuts). Laparoscopic and robotic-assisted surgeries are minimally invasive.

Laparoscopic surgery

In laparoscopic surgery, your surgeon will make a small incision on your abdomen (belly). They will put a laparoscope through the incision. The laparoscope is a long, thin tool with a video camera. It lets your surgeon see inside your body. 

Your surgeon may also put long, skinny surgery tools into other small cuts on your abdomen. They can use the tools to remove pancreatic cysts, tumors, and all or part of the gland. They may also reconstruct (rebuild) the digestive system during this procedure.

With a laparoscopic surgery, your surgeon directly controls the surgical tools with their hands. They can see the images from the laparoscope on a monitor. 

Robot-assisted laparoscopic surgery

With a robot-assisted surgery, your surgeon uses the  da Vinci® Surgical System. They sit at a console and control a robot that moves the surgical tools. There are hand, finger, and foot controls. The console has a special monitor where they can see the images from the laparoscope in 3D. 

Robot-assisted surgery can help your surgeon be more accurate than other minimally invasive methods. MSK’s operating rooms have the latest technology, including 9 robotic platforms.

Benefits of minimally invasive pancreatic cancer surgery

Minimally invasive surgery is a better option for some people than regular surgery. Benefits include:

  • Loss of less blood. 
  • A shorter hospital stay. 
  • A faster recovery. 

Pancreatic Cancer Surgery FAQs

When is pancreatic cancer surgery the best treatment option?

  • It’s for tumors that are only in the pancreas. They have not spread and grown into blood vessels (arteries and veins). MSK experts will diagnose pancreatic cancer and whether it has spread. 
  • It’s for a tumor that surgery can completely remove. 
  • It’s for precancerous lesions in the pancreas. 

When is surgery not an option for pancreatic cancer?

Many people have tumors that cannot be operated on by the time they learn they have pancreatic cancer. The tumors already have spread to other areas because the cancer is diagnosed at such a late stage.

MSK experts will not recommend surgery or other procedures if they decide there are few benefits compared with side effects. 

Does MSK combine surgery with another pancreatic cancer treatment?

Before treatment starts, your care team will talk with you about your best treatment options. You may talk with your surgeon, medical oncologist (cancer doctors), and radiation oncologist (doctor who treats cancer with radiation).

You may have chemotherapy or radiation therapy before surgery to shrink a tumor. This method is called  neoadjuvant (NEE-oh-A-joo-vant) therapy. Neoadjuvant means treatment before surgery. It can make surgery safer.