Surgery for cancer of the pancreas
Surgery provides the only opportunity for cure in patients with pancreatic cancer. Given the nature of the disease, unfortunately the vast majority of patients are inoperable at presentation. Approximately 10 to 15% of patients are candidates for surgery and this will be determined by preoperative staging with CT scan, endoscopic ultrasound scan and PET scan.
Tumours at the head of pancreas are treated by pancreatoduodenectomy (Whipple procedure) which involves removal of the duodenum, gallbladder, lower bile duct and head and uncinate process of the pancreas. Intestinal continuity involves joining the small intestine to the pancreas, bile duct and stomach in that order.
The Royal Surrey County Hospital has excellent results from pancreatoduodenectomy with data presented at the Association of Surgeons of Great Britain and Ireland in 2015, presenting an operative mortality in the region of 1%. Approximately 5% of patients may develop complications which might necessitate further surgery, and less than 10% of patients can develop a fistula or leak of pancreatic juice from the anastomosis.
Other complications associated with pancreatic head resection include the development of diabetes, requiring insulin, and most patients require enzyme supplements to ensure optimal absorption of foodstuff.
Surgery for cancer for body and tail of pancreas
Tumours that involve the body and tail of pancreas are treated by an operation that is known as distal pancreatectomy. This often involves removal of the spleen and the surrounding lymph nodes, and Mr Worthington performs laparoscopic (keyhole) approach in the vast majority of these patients.
The operative mortality for distal pancreatectomy is approximately 1% with less than 5% of patients requiring a return to the operating theatre and less than 10% requiring a blood transfusion.
To prevent the complications associated with splenectomy, the vast majority of patients are immunised preoperatively with vaccinations to guard against pneumococcus, meningococcus and haemophilus influenzae.
Chemotherapy for pancreatic cancer
Chemotherapy is often given to patients with pancreatic cancer, whether it be as an adjuvant (additional) treatment or in patients where surgery is not possible. A variety of agents are used, ranging from gemcitabine to capecitabine and, more recently, improved results have been seen with FOLFIRINOX chemotherapy which involves a combination of treatments with improved response rates, but associated higher adverse reaction. Radiotherapy is also used in patients with pancreatic cancer, again both as an adjuvant to surgery and in patients where surgery is not possible.