If the tumor is considered resectable (that is, if it can be removed by cutting it out), there are two surgical procedures offered. The type of procedure offered will depend on the location of the tumor.
- The Whipple Procedure
- Distal Pancreatectomy and Splenectomy
The Whipple Procedure
Also called a pancreaticoduodenectomy, the Whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. It is a surgery in which the head of the pancreas, gallbladder, stomach and part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin.
In the beginning of the procedure, the surgeon will decide whether the tumor can be removed. The pancreas is examined by an open incision or by laparoscopic instruments. If the cancer has not spread to surrounding tissues, your surgeon will continue to perform the Whipple procedure.
The neck of the pancreas is divided in front of the portal vein. The duodenum is divided below the stomach, and farther downstream. The bile duct is divided just above the gallbladder. The pancreas, bile duct, and stomach have to be reconnected to the small intestine. This restores digestive function by re-establishing the flow of pancreatic juice from the pancreatic duct, bile from the bile duct, and food from the stomach. The specimen removed includes the head of the pancreas with the tumor and lymph nodes, a segment of duodenum, the bile duct, and the gallbladder. In some cases, the tumor has grown into the portal vein. In selected patients, a segment of the vein can be removed along with the tumor. The vein can be replaced using the internal jugular vein from the neck.
The next steps reconnect the intestinal tract. The stomach is connected to the small intestine, and the bile duct and remaining portion of the pancreas are reattached. Several tubes be implanted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body will be implanted.
Distal Pancreatectomy and Splenectomy
A distal pancreatectomy is the removal of the end of the pancreas while leaving the pancreatic head attached. It is performed to treat pancreatic cancer localized in the end of the pancreas, but may also be used for chronic pancreatitis, pancreatic pseudocysts, and injury due to trauma. When the disease affects the splenic artery or vein, the adjacent spleen is often removed.
After removal of the end of the pancreas, the remaining portion of the organ functions normally by producing and releasing digestive enzymes and hormones. Compared to surgical procedures that remove the head of the pancreas, a distal pancreatectomy is performed in much less time and requires a shorter recovery period. The procedure can also be performed using laparoscopic instruments. Usually, patients undergo radiation therapy or chemotherapy in addition to the surgical procedure.
Tumors in the tail of the pancreas are removed with a distal pancreatectomy. In cases of cancer, the tumor often invades the splenic artery or vein. In addition, cancers in this location can spread to the lymph nodes in the hilum of the spleen. For these reasons, it is frequently best to remove the spleen along with the tail of the pancreas.
The pancreatic duct and cut edge of the pancreas is oversewn in an effort to prevent any leak of pancreatic juice.