This page contains information regarding the most common surgical approaches we use to manage certain diseases of the pancreas, mainly pancreatic cancer and other benign and non-benign tumors.
You have been advised that an operation to remove the tumor from your pancreas may be possible. There are several different operations used to treat pancreatic tumors. We know that removing this tumor by an operation is the only way in which it may be cured.
To find out whether this is possible for you, we will look at:
- The size of the tumor.
- Where it is in the pancreas.
- Whether it has grown into the tissues around the pancreas.
- Whether the tumor has grown into the major blood vessels in or around the pancreas.
- Whether it has spread to any other parts of the body.
The answers to some of these questions can be found from your pre-operative tests. We will have looked at the CT scan you had. Your scans may show the size and position of the tumor, which helps us plan your surgery. Scans may also show up cancer spread to other parts of the body. Sometimes spread of the tumor to other organs or major blood vessels may only be confirmed at the time of surgery and preclude you from a major resection.
If it is possible to remove your tumor you may be offered one of the following operations namely:
Whipple’s operation (pancreaticoduodenectomy)
These are highly specialised operations that require great surgical skill and expertise, as well as intensive monitoring and care during and after the operation. We perform these operations on a regular basis and have a team of doctors that understand the intricacies involved in this type of surgery at all levels.The second diagram shows how you will look inside after the operation when the cancer has been removed
Having your operation
Before your surgery, you will need to see a physician for a pre-operative appointment. The same physician will generally look after you in the post-operative period in the Intensive care unit or high-care unit. The physician will have all your safety checks carried out which include:
- Blood tests to check your general health and kidney function.
- A chest X-ray and lung functions test to check your lungs are healthy.
- Tests to check your heart is healthy (an ECG) .
- Further tests may be necessary based on individual needs.
You may have had some of these tests while your cancer was being diagnosed. Blood tests may have to be done often because the balance of chemicals in your blood can change so quickly. It is important that your surgeon knows your blood chemical levels are accurate and up to date.
Informed consent forms will be filled in and have to be signed by you before the surgery. This will be done in the rooms of the surgeon. We will provide you with DVT stockings which help to prevent clots in the legs and an abdominal binder which helps with pain control and to help wound healing and closure. These have to be purchased by yourself before the surgery and are not essential but recommended by our team.
Your physiotherapist will teach you breathing and leg exercises. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to.
Breathing exercises will help to stop you getting a chest infection and leg exercises will help to stop clots forming in your legs. Both these complications of surgery can happen because you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation. Remember – if you stop or reduce your smoking before your operation, you will significantly reduce your risk of getting a chest infection after your surgery. When you go into hospital for your operation, your surgeon and anaesthetist will all come to talk to you about what will happen. Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic. Do ask as many questions as you need to. The more you know about what is going to happen, the less frightening it will seem. We believe in the benefits of complementary medicine. We offer a healer to come and visit you at your bedside the morning of the surgery. This will help prepare your body for the surgery and to help put your mind at ease. This is completely optional. Medical aides do not cover this treatment and payment will be for your own account. The cost can be discussed with your surgeon or healer. Please speak to your surgeon about this if you are keen.
This is very major surgery. It involves taking out the whole of the pancreas, your duodenum, a small portion of your stomach, the gall bladder and part of your bile duct, the spleen and many of the surrounding lymph nodes. As you will not have any pancreas left after this surgery, you will need lifelong insulin injections to prevent the development of diabetes. Furthermore, you will need enzyme supplementation, which involves taking a tablet before every meal to assist your digestive system to absorb some of the nutrients in the food you eat. Getting over this type of surgery is hard work. It will take time to get back to eating normally
Complications of major pancreatic surgery
A complication is something that happens after surgery that makes your recovery more difficult. Chest infections or blood clots are both common complications after any surgery.
All these operations are major surgery and involve certain risks. Make sure you discuss the possible complications with your surgeon and ask all the questions you need to ask. It is important that your family members are given the chance to talk things through with the surgeon as well.
The most common complications and the percentage of patients who develop them are:
- Bleeding 5%: You may have bleeding shortly after your operation because a blood vessel tie is leaking or because your blood is not clotting properly. Bleeding in a few days following surgery can occur because there is infection or a leak from your pancreatic join to the intestine. The manner in which the bleeding episode is treated depends on what is causing it.
- Leak or fistula 10-15% : A ‘fistula’ is an opening. In this case, it means that part of the internal stitching to the digestive system has come apart or broken down. This results in some of the digestive juices being able to get into your abdomen. Drains put in during the operation will be left in until the fistula dries up. The fistula then usually heals on its own. Sometimes surgery is needed to repair the leak or fistula.
- Infection 25% : Infection can develop because there is blood or tissue fluid collecting internally around the operation site or because there is internal bleeding. If you develop an internal infection, you will be given antibiotics through your drip. Abscesses or any fluid that has collected internally will need to be drained. Draining the abscess is performed usually by putting in a drainage tube. The needle or tube is guided into place with X-ray or ultrasound.
- Chest infection : is a common complication of many operations. It happens because you are not moving around enough, or breathing deeply enough after your surgery. What you would normally cough up stays in your lungs and becomes a focus for infection. You can help prevent this by doing your deep breathing exercises. The physiotherapists and nurses will get you up as soon as possible to help you get moving. You will have had heart tests before your surgery, but these are very big operations and do increase the strain on your heart.
- Heart Problems : Some people develop heart problems after surgery that weren’t evident before the operation. Complications after surgery can be very serious. They are becoming less common as more of these operations are done in specialist centers.
Nonetheless, as many as 5-9% of people who have this major surgery die directly as a result of complications after their operation.