Surgery for Pancreatic Cancer

In this complex operation, surgeons remove part of your stomach, part of your small intestine (the duodenum and part of the jejunum), your bile duct that's outside your liver, your gallbladder and the wide end of your pancreas near the center of your abdomen (called the head, neck and uncinate process). Then they pull your remaining jejunum up and connect your remaining bile duct, pancreas and stomach to it.

If cancer is in the tail of your pancreas (the narrow end, near your side) and not in the head, your surgeon may remove the tail and body of your pancreas. Whenever possible, our surgeons try to leave your spleen. But they may have to remove it in order to get all the nearby lymph nodes where cancer cells might have spread.

In some situations, surgeons remove the whole pancreas along with nearby structures. Your surgeon may recommend this if your tumor is large, it involves almost your whole pancreas or it spans the central area from the neck to the body of the pancreas.

This approach may also be used for people with familial pancreatic cancer (at least two people in the family have had pancreatic adenocarcinoma, and they are first-degree relatives, like a parent and child or two siblings). They might have a Whipple procedure or distal pancreatectomy first. Then if follow-up care shows a lesion has formed in their remaining pancreas, surgeons may take out the rest of the organ.

The Appleby procedure was first developed to treat stomach cancer. A modified Appleby procedure may be an option for pancreatic tumors that affect nearby parts of the body (locally advanced) and that involve the celiac axis — the major blood vessels that feed the stomach, liver and spleen. The surgeon carefully removes the cancer and main blood vessels. They do this in a way that lets your body reverse the blood flow in the remaining vessels to supply vital organs, like your stomach and liver.