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PANCREATIC SURGERY FOR ADULTS

PANCREATIC SURGERY FOR ADULTS

PANCREATIC SURGERY FOR CANCER

Patients with pancreatic cancer need this operation because it is the most effective way of removing the tumor in the pancreas. A pancreatic resection is a surgical operation to remove the tumor from the pancreas. This is a complex operation because of where the pancreas sits in the body and its connections to other digestive organs. The pancreas is joined to both the intestine and the bile duct, so during the operation, depending on the extent of your disease and the type of pancreatic resection being performed, these parts of the body may also have to be removed and reconnected

Different types of pancreatic resection:

Pancreatico-duodenectomy (Whipple’s procedure): This operation is done when the tumor is located in the head of pancreas, lower end of the bile duct or in the duodenum. This is the most commonly performed pancreatic resection, it was first described by an American surgeon named Dr. A.O. Whipple. More commonly this operations is called “Whipple’s procedure”. It involves the removal of the head of the pancreas (30%-40% of the gland), the duodenum (early part of the small intestine), part of the bile duct and gallbladder. There is a small chance that you may become diabetic following this surgery, or if you are already diabetic, it may affect your diabetic control.

Distal pancreatectomy:  If the tumor in the pancreas is in the body or tail of the pancreas you will be able to undergo a distal pancreatectomy – the removal of the tail and body of the pancreas along with the spleen. The spleen needs to be removed because it is closely applied to the tail of the pancreas. This operation can also be performed laparoscopically (key hole surgery) and this is something that will be offered to you if it is indicated. If you are already a diabetic, you may have a period of variable diabetes control post-operatively.

Total pancreatectomy (complete removal of the pancreas): This involves the removal of the whole of the pancreas, the duodenum, distal extra-hepatic bile ducts, gallbladder and spleen. Following a total pancreatectomy all patients will become diabetic and will require insulin.

Treatment options depend on the stage of the disease, your age and your fitness to undergo major surgery. Surgical removal of cancer offers the only chance for cure. However, only a small proportion of patients (15%-25%) are suitable for surgical resection. After your surgery, depending on the stage of the disease and the outcome of your operation, you may also need chemotherapy.

All the patients who are not suitable for surgery, or who choose not to have surgery, may have their jaundice relieved by inserting a tube through the tumor into the bile duct during a procedure called ERCP. This is done without an open operation through a flexible telescope passed into the mouth down the throat and into the stomach and small intestine.

Alternatives to pancreatic resection:

Treatment options depend on the stage of the disease, your age and your fitness to undergo major surgery. Surgical removal of cancer offers the only chance for cure. However, only a small proportion of patients (15%-25%) are suitable for surgical resection. After your surgery, depending on the stage of the disease and the outcome of your operation, you may also need chemotherapy.

All the patients who are not suitable for surgery, or who choose not to have surgery, may have their jaundice relieved by inserting a tube through the tumor into the bile duct during a procedure called ERCP. This is done without an open operation through a flexible telescope passed into the mouth down the throat and into the stomach and small intestine.

Alternatively the stent can be placed through a Percutaneous Transhepatic Cholangio-gram (PTC). This is performed by an interventional radiologist and the stent is inserted percutaneously (through the skin) directly into the liver.

Chemotherapy:  The treatment of cancer with drugs is called chemotherapy). This treatment may be offered as a palliative treatment, where surgery is not possible, or as an add-on to surgical treatment. The aim of the palliative it to potentially slow down and/or shrink the cancer. As an “add-on” (adjuvant) treatment, it is offered to treat any cancer that may remain after surgery. Each dose of chemotherapy (single or combination) is called a cycle, each cycle is usually separated by a 2-3 weeks of a recovery period. This allows your body to receive the treatment, react/respond and recover.

Unfortunately, with pancreatic cancer, it is very difficult to predict whether it will respond to chemotherapy. However, in some people, even if a response is not achieved, they may find it can alleviate their symptoms and may prolong their life expectancy.

 

Alternatively the stent can be placed through a Percutaneous Transhepatic Cholangio-gram (PTC). This is performed by an interventional radiologist and the stent is inserted percutaneously (through the skin) directly into the liver.

Chemotherapy:  The treatment of cancer with drugs is called chemotherapy). This treatment may be offered as a palliative treatment, where surgery is not possible, or as an add-on to surgical treatment. The aim of the palliative it to potentially slow down and/or shrink the cancer. As an “add-on” (adjuvant) treatment, it is offered to treat any cancer that may remain after surgery. Each dose of chemotherapy (single or combination) is called a cycle, each cycle is usually separated by a 2-3 weeks of a recovery period. This allows your body to receive the treatment, react/respond and recover. Unfortunately, with pancreatic cancer, it is very difficult to predict whether it will respond to chemotherapy. However, in some people, even if a response is not achieved, they may find it can alleviate their symptoms and may prolong their life expectancy.

During the operation:

The surgeon will make quite a large cut (incision) across your abdomen. He/she will then check that everything appears to be as expected from CT scans. The part of your pancreas containing the tumor will be isolated. Once the diseased part of the pancreas is removed then the other organs will all be reconnected. Connecting the parts back together takes time and is complex work. Once completed, everything is checked and the incision is closed by several layers of stitching. Every patient and their surgery is different, so it is impossible to predict exactly how long a particular operation will take, but most pancreatic operations take about six hours to complete.

AFTER THE OPERATION:

A pancreatic resection is a major operation and you will usually have to stay in the Intensive Care Unit for a short while afterwards (usually 24 – 48 hours). This allows the team to closely monitor your progress and recovery. When you are ready we will transfer you to the ward.

Wounds and drains: The cut in your skin is usually stitched up with dissolvable stitches, so there is no need for stitches to be removed. The surgeon will place drains in your abdomen to remove fluids from the operation site. These will be removed approximately four – five days after the operation.

Circulation: The nurse will need to check your blood pressure and pulse regularly – initially every hour, then every two to four hours. You will have a small tube in one of your arteries to measure your blood pressure.

Breathing: You will need to wear an oxygen mask for the first 24 – 48 hours following your operation. This is to help with your breathing and recovery. In rare cases, you may still require help from a breathing machine when you leave theatre. However, in most cases the tube in your throat will be removed immediately after surgery. The physiotherapist will see you every day during your stay on the ward and encourage you to practice deep breathing exercises. This is important as it will help prevent you developing a chest infection.

Eating and drinking: You will not be allowed to eat or drink for up to 3-4 days following your operation. To help stop you being sick we may place a tube from your nose to your stomach. You will have a drip in a vein in your neck and your arm to provide essential fluid while you cannot drink. When you are feeling better you will be asked to start drinking and eating again by taking sips of water and then gradually building up to a normal diet over the course of a few days. By this time the drip in your neck or arm, and the tube in your nose will be removed.

The pancreas plays an important role in controlling how sugar is stored in your body. For the first 48 hours we will need to check your blood sugar at least every six hours to ensure your pancreas is working normally. This involves pricking your finger with a small needle and squeezing a small sample of blood on to a sugar sensor stick. A lot of people will require insulin treatment, at least in the short term.

Passing urine: You will have a tube in your bladder (catheter) draining the urine into a bag, which the nurse will use to measure to monitor your progress.

Pain relief: You will have a pump to control your pain. This will either be an epidural (which runs through a tube in your back) or a PCA (patient controlled analgesia) pump, which connects to a small tube under the skin in your arm. You will be taught how to use this before you have your operation.

Pressure areas: It is important while you are in bed to change position regularly (at least every two hours) so that you can relieve the pressure on your bottom and heels. The nurses will help you to do this.

Getting moving again: You will be encouraged to get up and about the morning after your operation. The sooner this is done and the more you mobilise, the less likely it is that complications will occur. The nursing staff and physiotherapists will help you. You will also have a pair of white (TED) stockings on, as these help to improve the circulation in your legs and prevent blood clots forming. Please bring slippers with you to wear over the TED stockings to reduce the risk of you slipping when mobilising post-operatively.

Physiotherapy: After your operation you will be seen by the physiotherapist on the ward to check your chest and help you to begin mobilising again. Any general anaesthetic has an effect on the natural function of your lungs and your physiotherapist will help you to counteract this by teaching you breathing exercises and assisting you to cough effectively. Sitting out in a chair and walking around at an early stage are very important for your digestive system and for your circulation and chest, so don’t be surprised if you are encouraged to get out of bed on the day after your operation. You will be “attached” to a variety of tubes (one or more wound drains, a drip, a catheter and some form of pain relief) but your physiotherapist or the nursing staff will be able to help you with these and you will only be mobilising with their assistance in the early postoperative stages.

Washing: Initially you may feel too tired or weak to be able to walk to the bathroom so the nursing staff can help you to wash.

Medication: Please bring your normal medication with you when you come in to the hospital. You should continue to take your usual medication and this will prescribed for you (on your medication chart) and dispensed by the nursing staff. In addition, you will be given a small injection twice daily of heparin to prevent you getting blood clots in your legs. You may also be given antibiotics to help prevent infection.

Do:

  • try and sit out of bed as soon as you are encouraged to do so
  • the breathing exercises you are taught several times a day
  • let the nursing staff know if you are in pain

WHEN CAN YOU GO HOME?

You will be able to go home within 8-12 days after your operation. However, you may need to stay longer if there have been complications that require additional treatment.

By the time you go home you should be able to manage independently – although you will not feel completely back to your ‘old self’ and should take things slowly. The following information gives you some advice and simple exercises to continue with at home to aid your recovery.

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