Pancreatic Cancer – Whipple Procedure (Pancreaticoduodenectomy)

Patient Handout—Pancreatic Surgery

The pancreas is a glandular organ that secretes digestive enzymes and hormones. It lies beneath the stomach and is connected to the small intestine at the duodenum. Insulin and glucagon are the two hormones secreted directly into the bloodstream by the pancreas. Together they regulate blood glucose levels. Insulin lowers blood sugar levels and increases the amount of glucagon in the liver. Glucagon slowly increases the blood sugar level if it dips too low. The pancreas also produces digestive enzymes and helps neutralize chyme (partially digested food) and to break down proteins, fats, and starches.

Sometimes cancer can grow in the pancreas, resulting in pancreatitis or jaundice. If the cancer is blocking the bile duct, the skin can become yellow or orange. Because of this, bile is not being excreted in the stool, making the stool a light clay color. Bile backs up in the blood stream as the liver is unable to get rid of the bile. The kidneys will then attempt to filter it out causing the urine to become very dark. This is how a typical pancreatic cancer case first presents.

A very aggressive cancer, pancreatic cancer requires a combination of surgery, radiation, and chemotherapy. This gives the patient the best chance of eliminating or controlling the tumor. Blood tests, CT scans, or endoscopy may assist in determining further intervention and to see if the cancer has metastasized or if it is resectable.

A complicated surgery called a pancreaticoduodenectomy (Whipple procedure) may be available where cancer has not spread beyond the pancreas. Under general anesthesia, the pancreas is exposed through an abdominal incision and the head of the pancreas, the gallbladder, the bile duct, and the duodenum are removed. Additionally, part of the stomach may be removed as well. After the tumor is excised, the stomach, pancreas, liver, and its bile duct are reconnected to the intestines to reestablish digestive capability. While this is a long, complex surgery requiring about a week’s hospital stay, it is the best option for certain pancreatic cancer patients.