Type of Surgery
Surgery for cancer of the pancreas is only offered to patients whose tumor is localized and/or meets other criteria. Only about 10-20% of individuals with pancreatic cancer may be eligible for surgery. In these cases, surgical resection (removal) of the tumor from the pancreas (and resection of select surrounding tissues) gives the best chance for a cure and generally confers a better overall prognosis in contrast to medical therapy. This is one reason why so much effort is given in pre-operative evaluation to try to identify those patients who may be good candidates for surgery.
A Whipple procedure (or pancreaticoduodenectomy), is typically performed for patients who have tumors which are located in or near the head of the pancreas. This is a fairly extensive and somewhat complicated operation where the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed. Occasionally a portion of the stomach may also be removed. A total pancreatectomy is performed less frequently today.
Studies have shown that for good outcomes from the Whipple surgery, the experience of the center and the surgeon is important. At Roswell Park Cancer Institute our surgical team outcomes have been recognized and rewarded with a ‘Pancreaticoduodenectomy Center of Excellence’ designation.
There are two principles that need to be introduced at this time. Neoadjuvant is the term used for giving chemotherapy and/or radiation prior to surgery for potentially resectable pancreatic cancer disease. The use of neoadjuvant therapy is an area of research. According to some studies, chemoradiation may push back the cancer enough to allow some patients with apparent unresectable cancer of the pancreas who otherwise might not be candidates--to be eligible for surgical resection. Neoadjuvant therapy has the potential to eliminate any non-visible tumor cells that may not be removed by surgery alone.
Adjuvant therapy describes the practice of giving chemotherapy and/or radiotherapy after surgery to help augment the effects of surgery. Some patients who may be very elderly or in poor health, may choose not to receive any therapy.