What is pancreatic cancer surgery?

Surgery for pancreatic cancer removes part or all of the pancreas. Other organs might also be removed. You and your doctor will plan your surgery based on your wishes and the stage of the cancer. Every person's treatment plan and surgery are different. Your doctor will tell you what will be removed.

Depending upon where the cancer is located in your pancreas, your doctor may:

• Take out the thick end (head) of the pancreas, part of the small intestine, and other nearby tissues. The doctor may also remove part of the stomach. This is called a Whipple procedure.
• Take out the narrow end (tail) and the body of the pancreas. Often the spleen is also removed. This is called a distal pancreatectomy.
• Take out the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen, and nearby lymph nodes. This is called a total pancreatectomy.

You will be in the hospital for about a week after the surgery. You will probably be able to go back to work or your normal routine in about 1 month. It will probably take about 3 months until your strength is back to normal. You may need more treatment for the cancer. This may include chemotherapy or radiation.

Depending on the type of surgery you had, you may need to take enzyme supplements to replace the digestive enzymes made by the pancreas. In rare cases, the entire pancreas is removed, causing diabetes. If this is the case, you will need insulin to maintain blood sugar levels.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may be asked to follow a clear liquid diet for several days before surgery. Your doctor will tell you how to do this.
• You may be given antibiotic pills to take.
• You may need to empty your colon with an enema or laxative. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. You will probably want to nap often.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• For about 4 to 6 weeks after surgery, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• You may shower, but avoid taking baths until your doctor okays it. Pat the cut (incision) dry. If you still have a drain in place, follow your doctor's instructions about showering with your drain and how to empty and care for it. After showering, replace the dressing if you have one.
• Ask your doctor when you can drive again.
• You will probably be able to return to work about 4 weeks after you leave the hospital.
• Your doctor will tell you when you can have sex again.

Diet

• Sometimes the stomach empties food into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.
  • Avoid high-sugar foods—such as desserts, soda pop, and fruit juices—are most likely to cause dumping syndrome.
  • Do not drink liquids within a half hour before eating and up to an hour after eating. Liquids move food even more quickly into the small intestine. Quick emptying of the stomach increases the chance of diarrhea.
  • Eat slowly. Try to chew each bite about 20 times. Allow 20 to 30 minutes for each meal.
  • Eat 5 or 6 small meals or snacks a day. This may keep you from feeling too full after eating and may reduce problems with diarrhea and dumping syndrome.
• If the surgeon did not remove any part of your stomach, you can eat your normal diet. But the surgery affects everyone's digestion differently. You may need to eat more smaller meals instead of fewer larger meals. You may have to try several foods to see what tastes good to you.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Whenever you eat, you may have to take enzyme pills to replace those the pancreas makes. These help you digest your food, especially fat.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• You may have to take anti-ulcer medicine for stomach ulcers.
• You may have diabetes. If this is the case, you may have to check your blood sugar and give yourself insulin shots every day.
• You may need to take enzyme supplements to replace enzymes the pancreas makes.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• You may feel a ridge along the incision, or cut. This is normal, and it will go away in a few weeks.
• Wash the area daily with warm water and pat it dry.
• If you have strips of tape on the cut, leave the tape on for a week or until it falls off.
• You may see a small amount of clear or light red fluid staining your dressing. This is normal.

Exercise

• Regular exercise will help you regain strength. Start with walking every day. Your doctor will tell you when you can do more.