Pancreatic cancer surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sudarshana Datta, MD [2]


The mainstay of therapy for pancreatic cancer is surgery. The different surgical techniques that may be used for resectable pancreatic cancer include pancreaticoduodenectomy (Whipple Procedure), pylorus sparing Whipple procedure, distal pancreatectomy and total pancreatectomy. The method of surgical resection depends on the locally invasive characteristics and size of the neoplasm. The National Comprehensive Cancer Network (NCCN) has recommended certain guidelines on resectability of pancreatic neoplasms based on resection margins, probability of cure, age, and comorbidities. Extrapancreatic disease requires palliative therapy and curative resection is not performed in such patients. CA19-9 levels help predict the likelihood of complete resection, the prognosis of patients with resectable disease and the presence of occult metastasis.


  • In patients with pancreatic cancer, surgery is the primary modality of treatment.
  • Various methods of surgical resection may be employed and each of these has its own sets of risks and perioperative complications.
  • The benefits, risks and complications are discussed by the patient and surgical team before arriving at a well-informed decision. The method of surgical resection depends on the following features:[1][2][3]
    • Locally invasive characteristics of the neoplasm
    • Size

Criteria for Unresectability

Surgical methods of curative resection include:

The National Comprehensive Cancer Network (NCCN) has recommended certain guidelines on resectability of pancreatic neoplasms based on a statement passed by the American pancreatic association:[4][5][6][7][8]

Pancreaticoduodenectomy (Whipple Procedure)

Various features of Whipple procedure are as follows:[19][6][39][40][41][42][43][44]

Pylorus sparing Whipple procedure

Distal Pancreatectomy

Total Pancreatectomy

Various features of total pancreatectomy are as follows:[48][73][74][75][76][77][78][79]


CA 19-9 level

  • Elevated levels of CA19-9 can help in the following ways:[87]
    • Predict the likelihood of complete resection
    • Predict prognosis of patients with resectable pancreatic cancer
    • Predict the presence of occult metastasis
  • CA19-9 levels are not used to dictate the initial strategy for treatment of pancreatic cancer.

 Palliative Therapy

Palliative therapy in patients with pancreatic cancer mainly involves the management of symptoms arising as a result of complications of surgery:[88][89][90][91][92][93][94][95]



  • Types of stents:
    • Metal- costly, longer lifespan
    • Plastic- cheaper, need replacement every three months

Duodenal obstruction


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