Pancreatic Cancer Surgery | Types of Surgery | MedStar Health

The latest pancreatic cancer surgery techniques performed by one of the most experienced teams in the region

If you've been diagnosed with pancreatic cancer, it's important to know all of your options, including some that may be hard to find at other cancer centers. At MedStar Health, your cancer team includes surgeons who have extensive training and over 50 years of combined experience in every type of surgery to remove pancreatic tumors. From complex open surgery to minimally invasive techniques that use small incisions and laparoscopic or robotic approaches to operate with exceptional precision, we perform more surgeries on the pancreas than anyone else in the region. Our surgeons also specialize in Whipple procedures with venous and arterial reconstructions and left pancreatectomies with celiac axis resections.

Many patients come to our Center for Liver and Pancreas Surgery for a second opinion to ask about pancreatic tumors that other pancreatic cancer specialists have deemed inoperable. We are pioneers in some of the latest techniques and may offer innovative treatments unavailable elsewhere.

In addition, we work with a multidisciplinary team of doctors, including radiation oncologists, medical oncologists, gastroenterologists, hepatologists, interventional radiologists, and others to design a treatment plan personalized to you. This individualized plan will also involve the guidance and support of other specialists, including nutritionists, social workers, and rehabilitation therapists who will help you achieve your highest level of health during and after treatment. Sometimes surgery can cure pancreatic cancer, while other times the goal of surgery is to relieve symptoms and improve your quality of life.

Our approach

We're pioneers in minimally invasive surgery for pancreatic cancer.

Whenever possible, we take a minimally invasive approach with our surgeries, making a smaller incision(s) and using advanced techniques to optimize our patients' recovery. These may include:

  • Laparoscopic surgery: A laparoscope is a thin tube with a tiny video camera that allows our surgeons to view the targeted area in real time.

  • Robotic surgery: Using a sophisticated robotic platform, we control robotic arms, surgical instruments, and a high-definition camera to operate with the highest level of precision.

While conventional, open surgery is still recommended for some patients, a minimally invasive procedure means:

  • Less postoperative pain
  • Shorter hospitalization
  • Faster recovery (typically two to three weeks versus six weeks)
  • Much smaller scar

Minimally invasive pancreatic procedures are demanding, requiring surgeons who already have expertise with conventional approaches. Our experienced team is finding success with these newer techniques, and we’re among the few places in the country to offer them. We’ve also performed more of them than other centers in the Washington, D.C., area.

Types of pancreatic cancer surgery

Pancreaticoduodenectomy (Whipple procedure)

Commonly called the Whipple procedure, a pancreaticoduodenectomy is the most common pancreatic cancer surgery we perform. It involves removing the head of the pancreas, the duodenum, a portion of the bile duct, the gallbladder, and sometimes, the stomach. Then, our surgeons reconnect the remaining parts of the affected organs to the small intestines. It's a complex procedure that should be performed by surgeons like ours who regularly perform the surgery and are experienced in the latest minimally invasive techniques.


The Whipple Procedure Explained by Dr. Emily Winslow

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Laparoscopic or robotic pancreaticoduodenectomy (Whipple procedure)

We can also perform a laparoscopic-assisted Whipple procedure or robotic Whipple. Both of these are minimally-invasive approaches that use small incisions and specialized instruments to help patients heal faster with less pain and risk than open pancreatic surgeries.

Distal pancreatectomy

In a distal pancreatectomy, we remove the body and/or tail of the pancreas. In some cases, we also remove the spleen because it's located nearby and shares some of the blood vessels. This type of pancreatic surgery can be performed as an open procedure, but eligible patients may benefit from a minimally invasive approach using laparoscopic surgery or robotic surgery.

Distal pancreatectomy with celiac axis resection (Appleby procedure)

Sometimes pancreatic cancer affects the celiac artery, which supplies blood to the pancreas and other nearby organs. In these cases, your surgeon may consider an Appleby procedure which involves removing the left pancreas, spleen and the celiac artery. Then, we preserve blood flow to the liver and stomach by reconstructing or replacing the artery.

Laparoscopic or robotic distal pancreatectomy

During a laparoscopic distal pancreatectomy, our surgeons remove the same areas of the pancreas as the open procedure but with minimally invasive techniques. Through smaller incisions and specialized instruments, we're able to minimize scarring, decrease the risk of complications, and speed up recovery. We can also perform this type of pancreatic surgery robotically, which provides an enhanced, 3-D view of the surgical site. The robotic system allows our skilled surgeons to operate with unmatched precision through small incisions. These minimally invasive robotic techniques also translate to faster recoveries for our patients.

Total pancreatectomy

A total pancreatectomy is the removal of the entire pancreas as well as several other organs in the gastrointestinal tract, including parts of the stomach and small intestine, the common bile duct, the gallbladder, spleen, and any nearby lymph nodes. It's typically used to treat chronic pancreatitis when no other surgical options are available. However, in rare cases we may also perform this procedure to treat pancreatic cancer when cancer cells spread throughout the entire pancreas.

We can perform this procedure robotically, using minimally invasive techniques to optimize recovery. As a result, patients experience less pain, fewer complications, and shorter hospital stays than if they undergo the procedure as open surgery. Life without a pancreas means you'll need to adjust to new dietary changes and medication. Our skilled and compassionate team of specialists will help you to navigate these changes as you heal and return to the things you love.

Total pancreatectomy with auto islet cell transplant

Completely removing the pancreas will cause diabetes, but we offer an innovative way to limit its severity. Some patients are candidates for an auto islet cell transplant. During this advanced procedure, your own islet cells are removed and infused back into your liver, where they can implant and grow, producing insulin.

We are one of the only places in the country with a lab equipped to harvest islet cells, making this a unique offering at MedStar Health. In addition, our Center for Liver and Pancreas Surgery is one of few centers that offers the operation robotically, which helps patients recover more safely and quickly than the conventional operation.

Central Pancreatectomy

A central pancreatectomy is an uncommon procedure but one that may be used in very early-stage pancreatic cancers or for those with non-cancerous pancreatic tumors. It involves removing the middle of the pancreas, while reconnecting the left and the right sides of the remaining pancreas to the stomach or intestines.

What is a Central Pancreatectomy?

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Other considerations

Biliary obstructions

Sometimes, a pancreatic tumor blocks the tubes that transport bile. That causes a biliary obstruction, which requires treatment. Your doctor may recommend one of two approaches:

Follow-up care

Patients who have their spleen or pancreas removed (or who otherwise lose pancreatic function) receive additional follow-up care:

  • Insulin: You will need to follow a diabetic diet and take insulin if your pancreas is removed.
  • Pancreatic Enzyme Replacement: We treat pancreatic enzyme insufficiency to help aid digestion.
  • Vaccines: Certain vaccines are recommended for patients whose spleen is removed since the organ plays an important role in the immune system and your risk of infection rises without it.

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

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