Pancreaticoduodenectomy – i.e The Whipple Procedure

This is the most common operation to remove a cancer of the exocrine pancreas. It is also sometimes used to treat pancreatic NETs.

Click to watch a video of The Whipple Procedure

During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can enter the small intestine. The pieces of the small intestine (or the stomach and small intestine) are then reattached as well so that food can pass through the digestive tract.

In the best of hands, many patients still suffer complications from the surgery. These can include:

  •         Leaking from the various connections among organs that the surgeon has to make.
  •         Infections
  •         Bleeding
  •         Trouble with the stomach emptying itself after eating.

Other, longer-term complications can include weight loss, trouble digesting some foods, changes in bowel habits, and diabetes in some people.

Distal pancreatectomy

In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. This operation is used more often to treat PNETs found in the tail and body of the pancreas. It is seldom used to treat cancers of the exocrine pancreas because these tumors have usually already spread by the time they are found.

Total pancreatectomy

This operation was once used for tumors in the body or head of the pancreas. It removes the entire pancreas and the spleen. It is now seldom used to treat exocrine cancers of the pancreas because there doesn’t seem to be an advantage in removing the whole pancreas.

It is possible to live without a pancreas. But when the entire pancreas is removed, people are left without any islet cells, the cells that make insulin and other hormones that help maintain blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.

Palliative Care

Palliative care is NOT hospice care

Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. It is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Palliative care can address a broad range of issues, integrating an individual’s specific needs into care. A palliative care specialist will take the following issues into account for each patient: physical effects, emotional need, coping mechanisms, spiritual needs, caregiver needs and practical needs such as financial worries or insurance navigation.

A cancer patient should ask their oncologist for a referral, or you can view lists of palliative care doctors by state from the Center to Advance Palliative Care. 

Nikki Mitchell benefited from palliative care, and her caregiver Rhonda Miles, wishes it was offered at the beginning of her cancer diagnoses, instead of at the end. Read Rhonda’s blog post about this type of care, as well as the National Cancer Institute’s FAQs.



Many clinical trials are testing new combinations of chemotherapy drugs for pancreatic cancer. Studies have looked to see if combining gemcitabine with other drugs would help patients live longer. For example, adding capecitabine (Xeloda) to gemcitabine seems to help some patients. The combination of gemcitabine, irinotecan, and celecoxib (an arthritis drug) also shows promise.

Other studies are testing the best ways to combine chemotherapy with radiation therapy or newer targeted therapies.

Radiation therapy

Some current studies are looking at different ways to give radiation to treat exocrine pancreas cancer. These include intraoperative radiation therapy (in which a single large dose of radiation is given to the pancreas in the operating room at the time of surgery) and proton beam radiation (which uses a special type of radiation that might do less damage to nearby normal cells).

Targeted therapies

As researchers have learned more about what makes pancreatic cancer cells different from normal cells, they have developed newer drugs that should be able exploit these differences by attacking only specific targets. These targeted therapies may provide another option for treating pancreatic cancer. They may prove to be useful along with, or instead of, current treatments. In general, they seem to have fewer side effects than traditional chemo drugs. Looking for new targets to attack on cancers is an active area of research.

Growth factor inhibitors

Many types of cancer cells, including pancreatic cancer cells, have certain molecules on their surface that help them grow. These molecules are called growth factor receptors. One example is epidermal growth factor receptor (EGFR). Several drugs that target EGFR are now being studied. One, known as erlotinib (Tarceva), is already approved for use along with gemcitabine.

Anti-angiogenesis factors

All cancers depend on new blood vessels to nourish their growth. To block the growth of these vessels and thereby starve the tumor, scientists have developed anti-angiogenesis drugs. These are being studied in clinical trials for patients with pancreatic cancer.

Drugs that target the tumor stroma (supporting tissue)

Pancreatic cancer does not always respond well to chemotherapy. One reason may be the dense surrounding supportive tissue (stroma) in the tumor. The stroma seems to form a barrier that helps protect the cancer cells from the effects of chemo drugs. Researchers are now looking at drugs that attack the stroma directly to help break it down. This might allow chemo or other drugs to be more effective.

Other targeted therapies

Many drugs targeting other aspects of cancer cells are now being studied for use in pancreatic cancer. Some of these drugs, such as sunitinib (Sutent), have several different targets.

Patient Support / Help

  1. CREON – Enzyme medicine support programs
  2. Abbvie – patient assistance programs
  3. Medicare
  4. RX assistance
  5. Patient Help Network
  6. PAN Foundation – Assistance programs for:Chemotherapy induced nausea and vomiting, Exocrine Pancreatic Insufficiency and Neuroendocrine Tumors of Pancreatic Origin
  7. Partnership for Prescription Assistance
  8. Cancer Care – Financial assistance
  9. Air Charity Network – Free air transportation to healthcare facilities
  10. Patient Advocate Foundation – Co-pay relief program
  11. Benefits Check Up – Senior benefits
  12. – A list of financial resources, national and local service organizations, housing and travel assistance and medication and treatment cost assistance

High-volume Robotic Surgeons

Intuitive Surgical, the manufacturer of the da Vinci robot used for robotic pancreatic surgery, defines “high-volume” as any surgeon completing 25+ pancreatic surgeries. The exact numbers of surgeries are protected and thus surgeons cannot be ordered by volume. Surgeon’s names are listed instead of  the hospital/institution because a surgeon may leave for another institution and take their expertise with them. Therefore, all high-volume centers may not retain that title with surgeon turnover. Published data has suggested a similar notion – that improved outcomes follow high-volume surgeons when they go to a low-volume center.

Surgeon names and corresponding states complied by Michael J. Wright, M.S., Department of Surgery at Johns Hopkins School of Medicine.

Click your state below to see the high-volume surgeons in your state.

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