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Surgeries for the Pancreas

Primary treatment for pancreatic cancer is surgery. Surgery is also done as a palliative treatment with the presence of a precluded extrapancreatic disease. It occurs in both men and women and is deemed as the fourth-leading cause of deaths due to cancer. Some characteristic symptoms are weight loss, unrelenting pain especially at night, pain radiating to the mid-back or lower-back, pruritus, depression, ascites, palpable rectal metastatic mass.

Testing and diagnosis involves CBC count along with hepatobiliary tests, lipase levels, tumour markers, CT scan, transcutaneous ultrasonography, endoscopic ultrasonography, MRI, endoscopic retrograde cholangiopancreatography, and positron emission tomography scanning.

With surgery being the only option for curative treatment, the following resection options available:

Whipple procedure: Also known as pancreaticoduodenectomy the surgery is beneficial if the tumour is located in the head of the pancreas, for ductal pancreatic tumours, bile duct cancer or cholangiocarcinoma and masses in the duodenum. The procedure may involve the resection of the pancreatic head, duodenum, antrum of the stomach, and gall bladder. The distal pancreatic duct and biliary system are drained through anastomosis. All these organs share a common blood supply and so are removed together.


  • A bilateral subcostal incision or Chevron’s incision is made.

  • After exploring the abdomen for metastasis (the liver, mesentery base, mesocolon and pelvis are examined). a Kocher’s maneuver is performed.

  • The duodenum and the pancreatic head are mobilized to the midline exposing the IVC.

  • The hepatic flexure of the colon is brought down with a Cattle braasch maneuver.

  • An attempt is made to create a tunnel between the superior mesenteric vein and pancreas.

  • The right hepatic vein and portal vein are identified and dissection is started carefully from the free border of the lesser sac and common bile duct.

  • Following the dissection of the gall bladder, the common bile duct is divided at the junction.

  • The gastroduodenal is tied and the hepatoduodenal ligament is easily dissected.

  • The pancreas is cut and separated from the portal vein.

  • Reconstructive pancreaticojejunostomy or pancreaticogastrostomy is done.

  • Single layer, interrupted or continuous hepaticojejunostomy is carried out.

  • As a final step to reconstruction, a gastrojejunostomy is done.

Distal pancreatectomy – This procedure is useful for the resection of tumours in the body and tail of the pancreas. The distal portion of the pancreas containing the tumour is isolated. That segment is resected and the distal pancreatic duct is oversewn.

Total pancreatectomy – The surgery is extremely beneficial for tumours involving the pancreatic neck (tumour develops in the neck or originates from the neck). These patients are susceptible to the development of insulin-dependent diabetes.

Dr. Deepak manages pancreatic cancer with a multi-disciplinary approach and has many years of experience performing pancreaticoduodenectomies.

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