For operable pancreatic cancer, appropriate surgical procedures are:
- Pancreaticoduodenectomy (Whipple procedure)
- Distal pancreatectomy - for cancer in the body or tail.
- Total pancreatectomy is only performed in special cases.
With endoscopic retrograde cholangiopancreatography (ERCP) it is possible to perform:
- Endoscopic loop resection
Most patients with pancreatic cancer experience loss of weight and commonly malnutrition. In such cases, nutritional supplementation is applied from the time of the work-up until the operation. Resectable patients having a delay in the operation due to lasting jaundice or limited capacity, should have their fluid, electrolyte, and energy balance improved during the delay. Potassium should always be given preoperatively to jaundiced patients with prolonged bleeding time or too high INR.
Marking and fixing the operation specimen
For assessment of surgical results, a high-quality histopathological examination of the operation specimen is necessary. This should be done in a standardized way and the pathologist and surgeon should agree on which histopathological variables are significant.
Conferring regularly with a pathologist appears to significantly improve histological quality. In addition, the surgeon's understanding of the cancer's spreading pattern increases.
The specimens of distal resections (body and tail) are fixed in an ordinary way with 10 units of formalin per unit of tissue. Whipple specimens should preferably be delivered unfixed to the pathology department immediately after the operation. All important vessels, ductal structures, and resection surfaces (especially posterior resection surfaces) should be marked.
- Tumor localization
- Tumor size
- Histology type
- Resection margins (especially posterior/retroperitoneal surface)
- Vessel infiltration
- Perineural infiltration
- Lymph node metastasis
Since the pancreas is partially a retroperitoneal organ, local spreading to the posterior resection surface is very critical. It is therefore important that this resection surface is examined for tumor tissue and reported.