Pancreatic cancer surgery


 * Associate Editor-In-Chief:

Overview
The selection of a treatment intervention depends largely on the disease progression and the patient's stage of cancer. The most common surgical treatment for cancer involving the pancreas is the Whipple procedure.

Surgical Therapy
Treatment of pancreatic cancer depends on the stage of the cancer. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.

Spleen-preserving distal pancreatectomy can also be used as a method to remove a cancer running through centre of pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy. Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.

After surgery, adjuvant chemotherapy with gemcitabine may be offered to eliminate whatever cancerous tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of radiation therapy is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not.

Surgery can be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.

Criteria for Unresectability:
 * Tumor larger than 5 cm
 * Tumor invades adjacent tissue of organs (excluding duodenum)
 * Encasement, stenosis, or occlusion of the celiac artery, celiac artery branches, and/or SMA.
 * PV and/or SMV encasement (some centers will operate with venous invasion)
 * Hepatic metastases
 * Distant metastases (i.e. non regional lymph nodes)
 * Peritoneal carcinomatosis