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Overview

Most people never give a moment’s thought to the purpose and operation of their pancreas. Part of the digestive system, this small organ is deep within the abdomen, near the spine. It produces and releases enzymes that break down nutrients from food and delivers them throughout the body. It also creates hormones, such as insulin, to regulate metabolism.

If pancreatic problems develop, they can be quite serious. Some conditions respond well to medicines, but many require surgical treatment. Because the pancreas is hard to reach, pancreatic surgery is challenging and requires a high level of expertise.

At Yale Medicine, “Our surgeons are uniquely equipped to guide people through the process, including not only the surgical procedure, but also the transition back to health,” says Ronald R. Salem, MD,Yale Medicine section chief of Surgical Oncology.

What is pancreatic cancer?

It is estimated that 57,000 people developed pancreatic cancer annually in the United States and 47,000 will die from it, making it the fourth-leading cause of cancer deaths.

One reason this type of cancer is considered so lethal is that early-stage pancreatic cancer rarely causes any symptoms. It’s not usually detected until the disease is advanced. Symptoms of later-stage pancreatic disease may include weight loss, abdominal pain, and jaundice.

People with new-onset diabetes are at higher risk for pancreatic cancer. Rates are also high in women with the BRCA1 or BRCA2 breast cancer gene.

What other pancreatic conditions are treated with surgery?

Not all pancreatic abnormalities are cancerous.

Several different types of tumors and lesions can develop on the pancreas, most of which respond well to treatment, including surgery.

Conditions that may require pancreatic surgery include:

  • Pancreatic cysts, some of which may become cancers, if neglected
  • Chronic pancreatitis, or complications of longstanding inflammation 
  • Pancreatic neuroendocrine cancer, a less common form of cancer which arises from the hormone-secreting cells. This has a much better prognosis and may be treated in a less invasive manner.

What is it like to have pancreatic surgery?

Pancreatic surgery is a major operation, with a typical hospital stay ranging from a few days to several weeks. Full recovery may take up to two months.

Some pancreatic surgical procedures can be done via minimally invasive (laparoscopic) techniques, which have many advantages for patients—including less bleeding, lower risk of complications, faster healing and an overall quicker recovery.

Dr. Salem points out that surgeons are often the first physicians to discuss potential therapies and treatment options. The surgeon makes a recommendation about the best approach, based on his or her expertise.

Dr. Salem focuses his research on optimizing clinical outcomes for people undergoing pancreatic surgery. Patients benefit from access to innovative new treatments and cutting-edge clinical trials.

What is the Whipple procedure?

The Whipple procedure, the most common surgery for removal of pancreatic cancer, is a complex, multistep surgery.

Also referred to as a pancreaticoduodenectomy, the Whipple procedure may offer effective treatment for noncancerous lesions or cysts, if they are on the top portion of the pancreas. Also, it is sometimes used to remove cancers in the bile duct or the small intestine.

It involves:

  • Removal of the head of the pancreas, where most cancerous tumors are found
  • Removal of the first part of the small intestine (duodenum), the common bile duct, the gall bladder and sometimes a portion of the stomach
  • Reconnection of the intestine, bile duct and remaining portion of the pancreas

What other types of surgical procedures are used to treat pancreas problems?

Other types of surgical procedures performed on the pancreas include:

Distal pancreatectomy, often laparoscopic, to remove tumors on the body or tail of the pancreas 

Total pancreatectomy, though this procedure is rare

What makes Yale Medicine’s approach to treating pancreatic cancer unique?

Yale Medicine performs more than 100 pancreatic procedures each year, making it the highest-volume center for pancreatic surgery in the state of Connecticut.

“There is very strong information to suggest that the best results for surgery are obtained in high-volume centers,” says Dr. Salem.

Yale Cancer Center and Smilow Cancer Hospital are one of just a few National Institutes of Health-designated Comprehensive Cancer Centers in the country.

Among the important advantages Yale Medicine offers to people with pancreatic cancer are:

  • Easy access to specialized and comprehensive care for pancreatic cancer, including evaluation, diagnosis and treatment.
  • Multidisciplinary expertise in diagnostic imaging, pathology, gastroenterology, surgery, medical and radiation oncology and cancer genetics, with regular meetings for case management and treatment planning.
  • The opportunity to take part in groundbreaking clinical trials and innovative new treatments hard to find elsewhere.