Sometimes laparoscopy is done first to help determine the extent of the cancer and if it can be resected. For this procedure, the surgeon makes a few small incisions cuts in the abdomen belly and inserts long, thin instruments. One of these has a small video camera on the end so the surgeon can see inside the abdomen and look at the pancreas and other organs. Biopsy samples of tumors and other abnormal areas can show how far the cancer has spread. This is a very complex surgery and it can be very hard for patients.
It can cause complications and might take weeks or months to recover from fully. Fewer than 1 in 5 pancreatic cancers appear to be confined to the pancreas at the time they are found. Even then, not all of these cancers turn out to be truly resectable able to be completely removed. Sometimes after the surgeon starts the operation it becomes clear that the cancer has grown too far to be completely taken out.
This is because the planned operation would be very unlikely to cure the cancer and could still lead to major side effects. It would also lengthen the recovery time, which could delay other treatments. Even if all visible cancer is removed, often some cancer cells have already spread to other parts of the body.
These cells can grow into new tumors over time, which can be hard to treat. Curative surgery is done mainly to treat cancers in the head of the pancreas. Because these cancers are near the bile duct, they often cause jaundice, which sometimes allows them to be found early enough to be removed completely.
During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can still go into the small intestine.
The end pieces of the small intestine or the stomach and small intestine are then reattached so that food can pass through the digestive tract gut. Most often, this operation is done through a large incision cut down the middle of the belly. A Whipple procedure is a very complex operation that requires a surgeon with a lot of skill and experience. It carries a relatively high risk of complications that can be life threatening. Understand why it is important to see a pancreatic cancer specialist for your care.
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Personal Treatment. For Survival. Contributions to the Pancreatic Cancer Action Network are tax-deductible to the extent permitted by law. This figure shows a tumor on the head of the pancreas before Whipple procedure.
This figure shows the surgical separation of the 1 bile duct, 2 stomach, 3 head of the pancreas and 4 small intestine. This figure shows the re-attachment of the 5 bile duct to the small intestine, 6 remaining pancreas to the small intestine and 7 stomach to the small intestine. And again, neoplasms can be masses, tumors, cysts in the pancreas. And so a Whipple for a non-cancerous neoplasm is obviously curative. And a Whipple for pancreas cancer can also be curative.
Miller: If one has a pancreas cancer and they're going to undergo Whipple, the purpose of that would be to cure the cancer, I think, obviously, right? Scaife: Yeah. And because of the location of the head of the pancreas intimately involved with the bile duct and the first part of the small intestine, we have to rebuild all of those.
So we rebuild the pancreas. We rebuild the first part of the small intestine. And we rebuild the bile duct. But in the end, the patients can eat normally. They can eat any food they like. And they do quite well after recovering from the operation. Miller: Is there anything that you tell your patients in that preoperative period when you first meet them before they undergo the surgery? Scaife: We frequently tell patients that the surgery, again, takes six to eight hours.
They'll be in the hospital for approximately seven days. For a month after a big surgery like this, their appetite, their energy, and their strength will all be much lower than they normally expect. And it usually recovers four to six weeks after surgery. Anything someone has before surgery gets a little bit worse and harder to manage after surgery. So diabetes, high blood pressure are all a little bit harder to manage after a big operation like this. But it recovers about a week or two after surgery and goes back to their baseline.
Miller: So that's interesting. Do you use a team approach with another physician such as an internist to help manage the patient after the surgery if they have diabetes or other complications?
Scaife: Generally we manage it on our own. Because they're short-lived, we're able to manage it on our own. Miller: Do they ever experience diarrhea following pancreatic surgery?
Is that something that they need to worry about? Scaife: Yeah, chronic diarrhea after a Whipple operation is extremely uncommon, but not zero. Scaife: It's from operating on the stomach and re-plumbing it effectively to the small intestine or rebuilding that first part of the small intestine.
Some patients can have a syndrome where they eat rich foods, and the foods go through the stomach. And the next part of the small intestine, it's not used to seeing such rich foods, reacts by pouring a lot of water into the intestine. And that neurologic response can result in almost like a hot flash-type symptom. And then after all of that water gets emptied into the intestine, 30 to 60 minutes after a meal, patients can have diarrhea from the water flushing through their system.
It normally resolves on its own and the few patients that it doesn't, learn to eat around it so they don't stimulate those symptoms.
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