Surgery for Pancreatic Cancer

Surgery is the most effective treatment for pancreatic cancer. It may be the only approach needed for early cancer.

Many people with pancreatic cancer have tumors that are too large or complex, meaning they are located near critical blood vessels, to allow for surgery. In these instances, doctors at NYU Langone may be able to shrink the cancer using chemotherapy, radiation therapy, or a combination of both, to make surgery possible.

NYU Langone is a high volume center for pancreatic cancer surgery. Although surgery for pancreatic cancer is complex, mortality rates are only 1 percent for people undergoing these procedures at NYU Langone—a rate that’s lower than the national average, even among high-volume facilities. 

Whenever possible, NYU Langone surgeons use minimally invasive techniques. The type of surgery performed depends on the location and type of tumor. 

The pancreas, which is oblong, can be divided into three parts: the head, the body, and the tail. 

The head is the round portion of the organ located near the bile ducts and small intestine. It’s also near several major abdominal blood vessels, such as the portal vein and hepatic artery, which carry blood to the liver, and the mesenteric blood vessels, which carry blood to and from the intestines.

Tumors located near and even growing into portions of these vessels can be removed, but chemotherapy with or without radiation may be necessary before surgery can be performed.

Tumors may also occur in the middle part of the pancreas or in the elongated, narrow tail, which is near the spleen.

Whipple Procedure

NYU Langone surgeons often perform the Whipple procedure, also called a pancreaticoduodenectomy, for cancer found in the head of the pancreas.

During this surgery, a doctor removes the head of the organ and the first section of the small intestine, which is called the duodenum. The gallbladder, the portion of the common bile duct that empties into the duodenum, and some of the surrounding lymph nodes are also removed. Cancer tends to spread to the lymph nodes, small immune system organs, first.

Sometimes a portion of the stomach near the duodenum is also removed during a Whipple procedure, depending on your anatomy. Part of the portal vein may also be removed if pancreatic cancer has spread to that blood vessel. 

After the procedure, surgeons reconnect the small intestine to the remaining pancreas, bile duct, and stomach, so that you can digest food.

Total Pancreatectomy

Surgeons may perform a total pancreatectomy if cancer has spread throughout the pancreas or is found in several parts of the organ. Doctors may also use this surgery to treat people at high risk of cancer spreading throughout the gland or in some people with precancerous cysts that are throughout the gland.

During a total pancreatectomy, doctors remove the entire pancreas, the duodenum, part of the stomach, a portion of the bile duct, the gallbladder, and most of the surrounding lymph nodes. Often, the spleen, which is an immune system organ that helps filter the blood, is also removed. The surgeon reconnects the second section of the small intestine, called the jejunum, to the stomach and bile duct, so that you can continue to digest food. 

Because the pancreas produces insulin, which regulates blood sugar, its complete removal causes the development of type 1 diabetes. Our endocrinologists can help you prepare for and manage diabetes by showing you how to take insulin and monitor your blood sugar levels. NYU Langone nutritionists can help you understand how your diet affects blood sugar levels.

A total pancreatectomy also requires that you take digestive enzymes after you eat to replace those made by the pancreas.

Distal Pancreatectomy

A surgeon may use a distal pancreatectomy to manage cancer in the body or tail of the pancreas. During this procedure, the doctor removes these parts of the pancreas and may also take out the spleen.

Removing the spleen may be necessary, because the blood vessels that feed it lie underneath the pancreas. Pancreatic cancer may be growing into or pressing on these blood vessels.

Central Pancreatectomy

A central pancreatectomy is often used to remove pancreatic neuroendocrine tumors, which usually develop in the body of the pancreas. These cancers consist of functioning endocrine cells that produce hormones, such as insulin.

The procedure involves removing the middle part of the pancreas and preserving as much of the organ as possible. This helps to avoid the development of diabetes and conserve the production of digestive enzymes. 

After the central portion of the pancreas is removed, the remainder of the gland is attached to the stomach or small intestine to preserve the ability to digest food.

Surgical Approaches

NYU Langone surgeons can treat pancreatic cancer with minimally invasive procedures, including robotic-assisted and laparoscopic approaches, as well as traditional open surgery. 

Minimally Invasive Surgery

Many tumors in the pancreas can be removed safely via minimally invasive approaches, which do not require the large abdominal incision of “open” procedures, and offer a faster and easier recovery. 

Minimally invasive approaches are often used for tumors in the body and tail of the pancreas, but even tumors in the head that require a Whipple procedure can be removed laparoscopically. 

Our doctors are also some of the first in the New York City area to use robotic-assisted approaches for pancreatic surgery.

Robotic-Assisted Surgery

Doctors at our Robotic Surgery Center may use an advanced surgical system to perform pancreatic cancer surgery. The system consists of tiny surgical instruments mounted on three robotic arms. A fourth arm contains a video camera that creates magnified, high definition, three-dimensional images on a computer monitor to guide the surgeon during the procedure. 

During a robotic-assisted procedure, the surgical tools and camera are inserted through small incisions in the abdomen. The surgeon controls these instruments and the camera from a console in the operating room. 

Robotic surgery provides doctors with an excellent view of the cancer and the surrounding organs and blood vessels. It also enhances a surgeon’s ability to perform the delicate aspects of pancreatic surgery. The robotic arms have more precise movements and a better range of motion than the average surgeon’s hands. 

Hospital recovery time for robotic surgery may be several days, compared with several weeks for open procedures. 

Laparoscopic Surgery 

Laparoscopic surgery involves several small incisions in the abdomen. Through one incision the surgeon places a laparoscope, a lighted tube with a tiny camera that creates two-dimensional images of the cancer and the surrounding organs.

The doctor places small surgical tools through the remaining incisions to perform the operation. Laparoscopic surgery can reduce recovery time to several days, compared with several weeks for open surgery. 

Open Surgery

Open surgery, which requires a large abdominal incision, may be necessary, depending on the tumor’s location and the involvement of nearby structures, such as major blood vessels. People with large pancreatic tumors or abdominal scar tissue from previous surgeries may also need an open operation.

Hospital recovery time from open surgery may be up to two weeks. 

Whichever approach you require, our physicians ensure that you are as comfortable as possible and that you receive the supportive care you need.

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