Dr. Aditya Kulkarni is a Consultant of Laparoscopic and Robotic Gastrointestinal, Hepato-biliary-pancreatic, and Cancer Surgeon at the renowned Ruby Hall
Pancreatic cancer or periampullary cancer if detected in time, is treated by surgery. The periampullary cancer includes cancer of the head of the pancreas, distal bile duct (cholangiocarcinoma), duodenum and ampulla. Surgical removal of these tumours, if possible, offers the best chances of cure. The cancers in the pancreatic head are treated by Whipple procedure or pancreaticoduodenectomy and cancers in the body and tail is removed by distal pancreatectomy or distal pancreaticosplenectomy. Some tumours in the body of the pancreas can be removed by central pancreatectomy.
Whipple Procedure or Pancreaticoduodenectomy
Whipple procedure or pancreaticoduodenectomy is a complex surgical procedure, which is done to remove pancreatic cancer or tumours and cysts of the head of the pancreas and periampullary cancers. This operation is named after Allen Whipple, who was the first surgeon to perform this operation.
In this operation, head of the pancreas, bile duct, gall bladder, first part of the small intestine and a portion of the stomach is removed. Intestinal continuity is then restored by joining the cut end of the pancreas to small intestine or stomach, cut end of the bile duct is joined to small intestine and stomach is joined with the small intestine. It is a complex operation which takes several hours to complete and demands great skill and expertise. Moreover, sometimes these cancers are stuck to these vital blood vessels, which need to be cut and joined to achieve complete removal of the tumour.
Not all patients with pancreatic or periampullary cancer will undergo this operation. Only about 20 per cent of patients suffering from these cancers are eligible for surgical removal. In these patients, cancer has not spread to nearby blood vessels, liver, lungs and abdominal cavity.
The patient would stay in the hospital until he recovers. Initially, the patient is monitored in the ICU and is then shifted to the ward once the condition is more stable. once the movement of intestine returns oral feeding will be started. During this surgery, tubes are placed in the abdomen to monitor for bleeding or leakage and they will be removed once the secretions dry up. The recovery generally takes 8-10 days but can be prolonged if there are complications. There can be many complications following this surgery, but the most common ones are pancreatic fistula, delayed gastric emptying, bleeding and infection. At the time of discharge, most patients are eating a normal diet and can carry out activities of daily living. Depending on the stage of the tumour, you might be advised further chemotherapy or radiotherapy called adjuvant treatment.