OHSU

Palliative Surgery for Pancreatic Cancer

If the cancer has spread too far to be completely removed, surgery is palliative. Whenever possible we try to avoid palliative surgery. However, sometimes surgery may begin with the hope of removing all the cancer. If the surgeon discovers this is not possible, he or she may continue the surgery to relieve symptoms or prevent new ones. At other times, surgery may be the only way to relieve symptoms and provide comfort.

Cancers in the head of the pancreas can block the common bile duct as it passes through this part of the pancreas. This can cause pain and digestive problems when bile cannot reach the intestine, and bile chemicals will build up in the body.

There are two options for correcting a blocked bile duct. 

  • Your surgeon may do surgery to send bile directly to the small intestine, bypassing the pancreas. This may require a large incision in the abdomen, and recovery can take weeks. Sometimes this surgery can be done laparoscopically. However, during this procedure your surgeon may be able to cut the nerves leading to end from the pancreas or inject them with alcohol. This can reduce or get rid of any pain caused by the cancer. Sometimes the stomach connection to the duodenum can also be bypassed.  This keeps the duodenum from being blocked by cancer, which can cause pain and vomiting that requires surgery. Bypassing the duodenum before it is blocked can help avoid a second operation.
  • Another way of relieving a blocked bile duct does not involve surgery. Instead, a stent is placed in the duct to keep it open. This is usually done through an endoscope while you are sedated. The doctor passes the endoscope down your throat into the small intestine. Your doctor can then place the stent into the bile duct through the endoscope. The stent helps keep the bile duct open. If the stent becomes clogged, your doctor can clear it in another procedure. Larger stents can be used to keep the small intestine open if it is in danger of being blocked.

For most patients with pancreatic cancer, doctors try and use stents instead of surgery to keep the bile duct and other areas from being blocked by cancer. Your gastroenterologist may also place a stent before surgery to relieve jaundice and itching.