William Jarnagin, Chief of the Hepatopancreatobiliary Service, is part of Memorial Sloan Kettering's multidisciplinary team of experts caring for patients with pancreatic cancer.
Surgery is often the best way to extend life — and, in some cases, to eliminate cancer from the pancreas.
Our surgeons are experts in both traditional surgery and minimally invasive procedures for pancreatic cancer. These include complex open surgical techniques, laparoscopic surgery, and robot-assisted surgery. We’ve also pioneered innovations that have made pancreatic surgery a safe treatment for more people than ever before.
We’re one of the most experienced pancreatic cancer surgery teams in the country. Our surgeons perform more than 300 operations for people with this illness each year.
Currently surgery is considered the best 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
Surgery for pancreatic cancer is a complex procedure. Many people with pancreatic cancer have tumors that are considered not able to be operated on when they are diagnosed. We don’t recommend surgery or other unnecessarily extensive procedures if we determine they will have limited benefit for you.
Before you receive any treatment, our surgeons consult with our medical oncologists and radiation oncologists. In some cases, you can receive chemotherapy or radiation therapy before surgery to shrink a tumor. This approach, called neoadjuvant therapy, can sometimes make surgery safer and more effective for people with tumors in the pancreas that aren’t considered operable.
No matter which surgical procedure or approach you and your doctors choose, our goals are the same: to remove your cancer completely, to limit the spread of cancer cells, and to preserve your digestive function.
MSK surgeons have expertise in the following types of procedures:
The Whipple procedure is the most common type of surgery for pancreatic cancer. It is used to remove tumors that are confined to the head, or right portion, of the pancreas. It is also called pancreatoduodenectomy.
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 remaining stomach, bile duct, and 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) if it has been invaded by a pancreatic tumor. Although this procedure is complex, it is safe and effective for many patients.
A distal pancreatectomy is usually performed if you have tumors that are confined to the tail (left portion) of the pancreas. The surgeon removes the tail and sometimes part of the body of the pancreas and the spleen.
If diagnostic tests show that the cancer has spread throughout the pancreas, your surgeon may recommend a total pancreatectomy to remove 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.
Sometimes just the middle of the pancreas is removed, generally for benign (noncancerous) tumors. In this operation, the remaining pancreas is attached to the stomach or intestine.
Minimally Invasive Surgery for Pancreatic Cancer
Some operations can be performed with minimally invasive techniques, such as laparoscopic and robot-assisted surgery.
We perform minimally invasive surgery through small incisions in the abdomen. Compared with traditional surgery, minimally invasive surgery offers a number of potential benefits for you, including:
- less blood loss
- a shorter hospital stay
- quicker recovery
Although minimally invasive surgery is not the best treatment option for all people with pancreatic cancer, it is an option for some, especially those who need less extensive surgery. Our surgeons are experts in two types of minimally invasive surgery for pancreatic cancer: laparoscopic surgery and robot-assisted surgery.
In laparoscopic surgery, the surgeon inserts a laparoscope (a thin, lighted tube with a camera on its tip) through a tiny incision in the abdomen. 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.
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. This tool offers greater precision than other minimally invasive techniques.