Pancreatic Cancer- Surgical Treatment

Whipple Procedure /


Pylorus Preserving Pancreaticoduodenectomy (PPPD)



The treatment of cancer of the head and neck of the pancreas comes in the form of surgical removal of heads/neck of pancreas followed by +/- chemotherapy.

This post will only elaborate the common practice in Dr Tee’s clinic of surgery. This post includes normal organ arrangement, pancreatic anatomy and functions, surgery for pancreatic cancer and our standard practices.

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Normal abdominal organs

Before we delve into the surgery, lets have a look the 4 intra-abdominal organs above the umbilicus.

  1. Liver

  2. Gallbladder

  3. Stomach and

  4. Pancreas.






Anatomy of Pancreas



The pancreas is an organ lying behind the stomach. Its divided into 4 parts- the head, neck, body and tail.

Its tongue shaped, expanding from left to the right of our abdomen, overlaying the back bone (spine).

Look at the blood vessels behind the neck of the pancreas- the superior mesenteric vein and artery that are closely related to any growth in the pancreatic head and neck.


Functions of Pancreas


The pancreas is made up of cells that produce enzymes and hormones.

  1. Enzymes- to digest fat, carbohydrates and protein

  2. Hormone- Insulin (mostly), to control sugar level in our blood streams etc.

Diets after surgery- gradual normalization to standard diets.

Diabetic after surgery- depends on the risks factors before surgery, averagely < 25%.

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Pancreatic Cancer – Head and Neck



Whipple/PPPD Surgery

This is a major surgery, involes removing/resecting the following parts:

1. Bile duct and gallbladder

2. Upper part of duodenum

3. Head of pancreas

4. Upper part of jejunum (upper end of small intestine).


The above resection is followed by reconstruction of 3 areas:

1. Jejunum to pancreas

2. Jejunum to bile duct

3. Jejunum to distal end of stomach.





The incision and drains placement after surgery



The incision is made based on the position of the pancreas in our body. Numbness below the future will be felt and patient will feel and hear the intestine moving sound more prominently due to repositioning of gut after the reconstructive surgery.

The skin is closed normally using stapler and will be removed 10 days after the surgery.

Drains are placed temporary for drainage of fluid and residual blood. Most of the time they will be removed upon discharge.

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Our standard practice:


1. WHIPPLE / PPPD Surgery

2. Risks- Pancreatic duct leak (15%), bleeding, infection

3. ICU stay – at least 1-night stay.

4. Tubes- 2 drains, 1 x through the nose for feeding.

5. Average stay in the hospital – 5 to 7 days.

6. Average surgery duration – about 6 hours.

7. No weight lifting x 3 months for more than 3kg.

8. Cost of hospital stay and surgery– about RM 70,000 to RM 80000