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Pancreatic resection

Which patients are considered for pancreatic surgery?
Any patient with a primary pancreatic tumour in whom the tumour can be removed with clear margins, is potentially suitable for surgery, provided there is no evidence that the tumour has spread. Patients with tumours in the head of the pancreas will present with jaundice and have staging investigations (CT scan) and a stent inserted to relieve the jaundice, before surgery is considered. All patients are considered for an operation to remove the pancreatic tumour but this is considered inappropriate if the tumour has spread or is wrapped around the major blood vessels which are adjacent to the pancreas.

What happens in a pancreatic operation?
Pancreatic operations are performed under general anaesthetic and take between 4 and 8 hours to complete. The part of the pancreas affected by the tumour is removed with the exact operation depending on the tumour location. Tumours in the head of the pancreas are removed with an operation known as a Whipple’s procedure. This involves removing half of the pancreas (head and uncinate process), the common bile duct, the gallbladder, duodenum, distal stomach and proximal 10cm of small bowel. This is major operation with predicted inpatient stay of 14 days on average. A tumour in the body or tail of the pancreas is usually removed by an operation known as a distal pancreatectomy, which usually includes removal of the spleen en-bloc with the distal half of the pancreas. After surgery patients will often have an epidural catheter for pain relief, a urinary catheter, and an intravenous drip for fluid replacement. Up to 5% of patients may be suitable for a keyhole (laparoscopic) operation to remove their pancreatic tumour, the remaining patients however will need open surgery.

Is pancreatic surgery safe?
Pancreatic surgery is now routinely performed in specialist centres throughout the UK. The results of pancreatic surgery have improved dramatically over the past two decades and it is now regarded as a safe operation in specialist hands. An operative mortality rate of less than 5% for major pancreatic surgery is expected, and patients return to full activity after surgery in 8-12 weeks. Post operative complications including chest, urine and wound infections, pancreatic, bile and intestinal leaks. Pancreatic insufficiency requiring enzyme replacement occurs in up to 50% of patients. All patients undergoing a pancreatic operation have 4 units of blood available as blood transfusion is required after surgery in up to 50% of patients.

What are the benefits of surgical removal of the tumours? The aim of surgical resection of pancreatic tumours is to remove all of the cancer and any associated lymph nodes, with clear margins. Pancreatic resection has been shown to increase mean survival compared to other forms of treatment (chemotherapy), and is the only treatment for pancreatic cancer that offers the potential for cure. Any survival advantage from pancreatic surgery must in all cases however, be carefully weighed against the risks of major surgery, especially in high risk patients.

Will I need further treatment after my pancreatic operation?
This is dependent on the results of the pancreatic surgery and the type of tumour removed. Every patient will have an individual treatment plan after discussion between their surgeon and oncologist. There is clear evidence from major trials that the use of postoperative chemotherapy is beneficial for patients after removal of a pancreatic adenocarcinoma.

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