Early Diagnosis in High Risk Patients | Surgical Management
Pancreatic Cancer Clinic | New Therapies | Endoscopic Therapies | Quality of Life
Molecular Research: Proteomics | Molecular Research: Gene Identificaiton

Surgical Management

Currently, the only chance of a cure for pancreatic cancer is with surgery, though other treatments may have additional (adjuvant) benefit. The role of the surgeon is to educate and guide patients and their families through surgical treatment of pancreatic cancer, and to evaluate combined treatments and techniques for improving the safety and effectiveness of surgical therapy. Examples of such treatment include innovative pre-surgical treatment with chemotherapy and/or radiation, intraoperative radiation in selected circumstances, new surgical diagnostic techniques for evaluating the true extent of the cancer, and defining the appropriate role of radical surgical therapy.

Removal of the Pancreas:
For patients who have been found through surveillance studies to have a high risk of pancreatic cancer, the only effective current treatment is removal of the pancreas, usually completely. When performed before the development or spread of invasive adenocarcinoma, this treatment is curative. Unfortunately, most patients are found to have pancreatic adenocarcinoma when the cancer is quite advanced and causing symptoms. Even in this group of patients, if the cancer is confined to the pancreas and not involving regional vital structures such as major blood vessels, some patients can be cured by removal of the cancer, the surrounding region of normal pancreas, and regional lymph nodes. Since these lymph nodes run with the regional blood supply, surgery of this nature often requires removal of adjacent structures that share blood supply with the tumor.

The Whipple Procedure:
Most cancers of the pancreas develop in the head of the pancreas where 55% of the pancreatic mass is found. Regional resection of a pancreatic cancer developing in the head of the pancreas requires removal of the duodenum, part of the bile duct, and often part of the stomach. This is termed a Whipple procedure. The Whipple procedure has over a hundred steps and often takes 6 to 9 hours to complete since the gastrointestinal tract must be reconstructed after the removal of the tumor. Tumors involving the body or tail of the pancreas are often harder to diagnose, more advanced when detected, and more difficult to cure. Again, when confined to the pancreas and regional tissues, surgical removal (usually including the spleen which shares blood supply and lymph node drainage) is termed a distal pancreatectomy and offers a chance of cure.

For both the Whipple and distal pancreatectomy, surgery is clearly only part of the answer since cure rates are at best 1 in 3 to 1 in 4 of all patients surgically treated and only a minority of patients are even candidates for surgery. Because of this overall poor cure rate with surgery, our oncologic surgeons work in close partnership with cancer biologists, medical and radiation oncologists, and our colleagues in radiology and pathology to use surgical techniques and biopsies to study the cancer, to deliver innovative therapies to the cancer directly, and to understand and improve the effectiveness of our cancer treatment. Most of the same issues apply to other cancers of the pancreas such as islet tumors, though adenocarcinoma remains the focus of study.