Advanced Surgical Techniques for Pancreatic Cancer

Surgery is the only known treatment for pancreatic cancer that has a definite, positive impact on survival for this disease.

Surgery is only used to remove cancers of the pancreas if all of the known cancer can be removed. The location of the tumor within the pancreas determines the type of surgery. If the cancer has not spread to any distant lymph nodes, blood vessels, or other organs, such as the liver, surgical treatment can be performed to remove the tumor.

Prior to surgery, each patient is evaluated by the medical team so that surgeons can develop an individualized treatment plan.

Surgeons at the Pancreatic Cancer Center perform a variety of advanced pancreatic surgical techniques that include:

Minimally Invasive Pancreatic Surgery

UPMC’s surgeons are highly experienced in minimally invasive (laparoscopic) pancreatic surgery, and recommend this approach for many patients. The benefits of minimally invasive surgery may include:

• Shorter hospital stays (typically two days shorter than traditional surgery)
• Faster recovery times
• Smaller incisions
• Reduced likelihood of needing a blood transfusion during surgery
• Safety appears to be identical to traditional surgery

Minimally invasive techniques are used on a weekly basis at the UPMC Pancreatic Cancer Center to:

• Remove tumors from the pancreas
• Diagnose and biopsy pancreatic tumors
• Place markers (gold fiducials) for specialized radiation to treat pancreatic cancer
• Bypass the stomach (creating a new route for food to leave the stomach) when large pancreatic tumors are blocking it
• Stage pancreatic cancers using ultrasound
• Drain pancreatic cysts to relieve symptoms

Through significant research efforts, UPMC’s pancreatic surgery team is working to improve and adapt laparoscopic surgery for additional types of pancreatic tumors.

Laparoscopic pancreatectomy

Laparoscopic pancreatic surgery involves removing a pancreatic tumor, and sometimes the spleen, through five or six half-inch-long incisions in the abdomen.

The surgical instruments are introduced into the abdomen through these small incisions along with a video camera (laparoscope) so that the surgical team can see the tissues.

Traditional Pancreatic Cancer Surgery

Pylorus preserving pancreaticoduodenectomy (Whipple)

The Whipple procedure (or radical pancreaticoduodenectomy) is used for removing tumors within the head of the pancreas, as well as the neck and uncinate process of the pancreas.

During surgery to remove the head of the pancreas, additional adjacent organs are removed to reduce the chance of cancer recurrence. These organs include: the duodenum, common bile duct, and gallbladder. The average hospital stay is 10 days.

Distal pancreatectomy

If the tumor is in the body or tail of the pancreas, a distal pancreatectomy is performed. The spleen is usually removed at the same time because the blood vessels and lymph nodes to the spleen run past the tumor in the pancreas.

Some types of tumors in the distal pancreas can be removed using minimally invasive techniques, although most are removed using traditional open surgery.

Distal pancreatectomy is associated with fewer postoperative problems than a Whipple procedure, because the surgery is not usually as extensive.

The average hospital stay is six to eight days, depending on the technique used to remove the tumor.