Liver, Pancreas and Bile Duct Program (HPB)
Pancreatic Cancer - Surgery
The best chance for cure of pancreatic cancer is provided by early diagnosis and surgical removal of the tumor. Surgery combined with the appropriate radiation and drug therapies can significantly extend survival.
Surgeon experience heavily influences a patient’s chances for improved outcome after surgery for pancreatic cancer. Highly specialized pancreatic surgeons at Froedtert & The Medical College of Wisconsin have a proven track record in performing a variety of advanced pancreatic surgical techniques, including pancreas-sparing tumor resections and surgeries to remove extensive tumors. They are international authorities on the treatment of pancreatic cancer, and they offer experienced guidance in disease management.
Our “Surgery Last” Approach
Whether or not a patient is eligible for surgery depends on many factors, including the size and location of the tumor and the stage of the disease.
For the last several decades, the standard care plan for operable pancreatic tumors has been surgery followed by radiation therapy and chemotherapy. Based on careful research, the care team at the Clinical Cancer Center strongly advocates a “surgery last” approach. Most patients with resectable or “borderline resectable” pancreatic tumors receive combined chemotherapy and radiation therapy (chemoradiation) prior to undergoing surgery to remove their tumor.
This approach provides a better chance of controlling the cancer and setting the stage for a successful surgery. To learn more, see Chemoradiation Before Surgery.
To find out more about how physicians stage pancreatic cancer and make treatment decisions, read The Importance of Accurate Diagnosis and Multimodality Therapy for Pancreatic Cancer.
All or part of the pancreas may be removed, depending on the location and size of the tumor, the stage of the disease, and the patient’s overall health. Our surgical oncologists offer the full range of surgical procedures for malignant pancreatic disease:
Pancreaticoduodenectomy (the Whipple procedure) is a surgery to remove a tumor in the head of the pancreas. This procedure involves removing the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, part of the common bile duct, and nearby lymph nodes. Read more about the Whipple Procedure.
Pancreatectomy is the surgical removal of all or part of the pancreas. In a total pancreatectomy, the entire pancreas is removed, usually along with the spleen, the gallbladder, the common bile duct, and portions of the small intestine and the stomach. After a total pancreatectomy, the body loses the ability to secrete insulin, digestive enzymes and other substances. These conditions are treated with pancreatic enzyme replacement therapy and insulin injections. In a distal pancreatectomy, only the body and tail of the pancreas are removed, leaving the head of the organ. Central pancreatectomy, in which only the middle section of the pancreas is removed, can be an option for some patients. Some patients are eligible for minimally invasive pancreatectomy using laparoscopic techniques.
Ampullectomy is the removal of tumors located in the ampulla of Vater, which is the junction of the pancreatic duct and the common bile duct at the point where they enter the small intestine.
Enucleation is a limited surgical resection in which the surgeon removes just the tumor and a surrounding rim of normal tissue, leaving most of the pancreas intact.
Portal and Superior Mesenteric Vein Resection
As pancreatic tumors grow, they often encroach upon adjacent blood vessels. Blood vessel involvement is a major challenge in pancreatic surgery and can cause patients to be ineligible for surgical treatment.
Surgical oncologists at Froedtert & The Medical College of Wisconsin are highly experienced in operating on pancreatic cancers that have invaded nearby veins. During a highly technical procedure, they are able to resect the portal vein and/or the superior mesenteric vein and reconstruct them using blood vessels from another part of the body.
To find out more, read Vein Resection at the Time of Whipple Procedure, by Douglas Evans, MD, and Kathleen Christians, MD, Medical College of Wisconsin surgical oncologists.
An increasing number of studies have reported an inverse relationship between hospital volume and surgical mortality. This has been seen with pancreatic resections, where high volume hospitals have a significantly lower mortality (strongest relationships were found in pancreatic and esophageal surgery).
Froedtert and the Medical College of Wisconsin is one of the highest volume pancreatic surgery referral centers in Wisconsin. From 2010-2013, over 260 pancreatectomies have been performed, the majority of which are pancreaticoduodenectomies (Whipple procedures). In addition, Froedtert and the Medical College of Wisconsin has one of the largest experiences of combined pancreatic resection and complex vascular reconstruction in the U.S. - accounting for 20% of cases performed since 2010.
After surgery, patients are cared for by a dedicated team of surgeons, specially trained nursing staff, dietitians and endocrine specialists. A standardized pathway has been developed to expedite a safe recovery after the operation which has resulted in an approximately 9-day median hospital stay. From 2010-2013, the reoperative rate after pancreatic surgery has been 0.07% and there have been no 30-day hospital mortalities.
From 2010-2013, the median survival for resectable patients who complete neoadjuvant therapy followed by surgery was 47.2 months. During the same time period, the survival for borderline resectable pancreatic cancer patients who completed all therapy was 21.8 months. These are among the best survival statistics for this challenging disease.
In addition, the MCW pancreas surgery program is one of the select institutions in the United States that have no perioperative mortalities related to pancreatic surgery (UHC data, 2013). Among the institutions who have zero mortality rate, the MCW pancreas program has the third highest volume of pancreatic surgeries.
See article by Dr. Douglas Evans, "Who is the Quarterback ? Navigating the Complex Healthcare Environment."
Care of Benign and Pre-Malignant Conditions
Surgical options are also considered for patients with some benign or premalignant pancreatic conditions, such as cysts or chronic pancreatitis.