In cancer of the pancreas after the patient is undergoing tests such as ultrasound, CT, endoscopic studies that inform the doctor about the amount and position of the tumor, it establishes the possibility of resection of the malignancy.
If there are no signs that the tumor has spread beyond the pancreas, and the patient is healthy enough to undergo surgery, doctors will decide on its conduct.
Before they find out the possibility of resection:
- How the tumor is large. neoplasms of the small size is easier to remove.
- Where is the tumor and whether it affected any major blood vessels or arteries.
- Do not penetrate the tumor process in the nearby lymph nodes or tissue.
- Do not spread to other parts of the body the cancer (eg, liver or lungs).
- The patient is healthy enough to move a major operation.
If you are interested in the possibility of treatment abroad, our company medical service «Unims», the organization can offer surgery to remove a tumor of the pancreas in Israel, the country's largest private medical center - Assuta. One of the characteristics of cancer treatment in Israel is the development of oncological surgery. Often inoperable tumors in other countries there may be successfully operated.
Let us consider the stages of surgical treatment of this disease in the hospital Assuta.
Pancreatic cancer in its early stages can be cured with the help of the following surgical procedures:
- Whipple operation.
- Total pancreatectomy.
- Distal pancreatectomy.
In some cases, the tumor can be located very close to the blood vessels or surgeons can not accurately determine whether the operation to be safe based on the images. Then it may be decided to begin surgery with the laparoscopic approach, to ensure that you can remove the tumor without harming the patient, before going on to complete the surgery.
In other cases, doctors may assign course of chemotherapy or chemoradiotherapy (along with low-dose radiation therapy chemotherapy) to remove pancreatic tumors, to try to reduce cancer and improve the chances of successful operation.
Diagnosis involves an assessment of the overall health as well. Some of the tests that are likely to be assigned to the operation: blood and urine tests, checking blood pressure, chest X-ray, electrocardiogram.
Other tests may include:
- Stress test (check the condition of the heart).
- Pulmonary function tests.
- Test for glucose tolerance (diabetes analysis).
- The test for elastase (check the pancreas work).
Before you remove a pancreatic tumor is signed consent form that gives permission for the operation doctors, and indicates that the patient understands the risks. Seen the anaesthesiologist is assigned in connection with general anesthesia. If the patient is taking medications such as aspirin, clopidogrel or warfarin, stop taking them.
The medical team, which interacts with the patients in the Assuta includes the following specialists:
- Surgeon - he carries out the operation in advance explains its essence, is about the potential risks and complications.
- The anesthesiologist responsible for the anesthesia during the removal of a pancreatic tumor. Advance discusses possible types of pain control with the patient.
- Physiotherapist postoperatively trains and deep breathing exercises for feet, which will contribute to prevention of infection and encourage the patient to be more mobile that will facilitate the healing process.
- Nutritionist assists in diet issues. We can meet up surgery to remove a pancreatic tumor, if the patient had problems with weight loss. Often need professional advice after surgery.
- The nurse can give advice and information about the surgical intervention.
Its other name - pancreatoduodenal resection- is the most common type of surgery aimed at removing the pancreas tumors. Typically, it is performed when the cancer is localized in the body of the head, and the patient has a fairly good state of health, that sustain a serious operation.
What happens during the Whipple operation?
Surgery usually lasts from 4 to 7 hours surgeons work aimed at complete resection of the tumor to provide the best chance of cure. Removed the head of the pancreas, part of the bile duct, duodenum, the pylorus. The remaining segments of the prostate, bile duct and stomach are connected to the small intestine. They can be removed adjacent lymph nodes.
A modified version of pancreatoduodenectomy
In this embodiment, the Whipple operation stored pylorus. Removed only part of the duodenum, and leave the doorman - a stomach segment that connects to the intestine. Some doctors believe that it helps the digestion process after surgery.
Both types of Whipple's operations are the main types of surgery with a high probability of complications. During removal pancreatic tumor applied general anesthesia. After this requires about 10 days of hospitalization.
The distal resection is usually performed as the tumor is localized in the body or tail of the body.
During the procedure removed the tail and body of the prostate and stored head. Often the spleen resection is performed at the same time, because it is located next to the body and the tail may be affected by a malignant process.
Although the distal resection is less complicated than the Whipple procedure, it is still a serious operation. The spleen is an important part of the immune system, in the case of the removal of the patient will have to take antibiotics to prevent infections of all the rest of his life.
In some cases, may conduct pancreatectomy using the laparoscopic approach, as a rule, in cases where the tumor is small. Since this endovascular intervention, recovery time is shorter.
This is a very serious operation, which involves removal of the entire pancreas, duodenum, part of the stomach, gallbladder, bile duct segment, spleen, lymph nodes, and many others. It is carried out very often, because there is no evidence that it is more effective in terms of increasing survival compared with Whipple's operations.
Indications for its conduct:
- Tumors were found in several places in the pancreas.
- Malignancy has spread along the duct body.
- There are specific and rare tumors, including precancerous (intraductal papillary mucinous tumor).
After surgery for pancreatic cancer
Surgical intervention can take from 4 to 8 hours.
After removal of the pancreatic tumor patient wakes up in the recovery room is usually located next to the operating room, where a nurse to take care of him. After that he was transferred to the intensive care unit for 2-3 days, where he was kept under close control. His watches specialist surgery department. hospitalization period is usually 10-14 days.
When the patient wakes up, thereto is usually connected dropper catheter depends on the operation:
- Mounted dropper into a vein in the hand and a neck, through which the body fluid enters or medicaments.
- Under the skin near the wound is usually placed drainage to remove excess liquid.
- The bladder catheter is set for the collection of urine. This means that do not have to worry about how to get out of bed to go to the toilet.
- Often used epidural catheter through it enters the anesthetic to relieve pain after surgery.
- It can be placed feeding tube introduced through the nose and going to the stomach.
All these devices are removed when they become unnecessary patient.
The pain threshold is different for each person. The team, working with the patient in the Assuta guaranteed will reduce the pain to a minimum. It is important that the patient reported if it feels or if sensations are amplified.
For pain control can be used:
- Epidural anesthesia is usually given immediately after surgery.
- Painkilling injections made every 3-4 hours.
- Analgesic suppositories are administered into the rectum.
- Patient controlled analgesia.
- Analgesics in the form of preparations.
Doctors will explain what type of painkillers will be given and how often.
It is important to start moving as soon as possible. Patients will be encouraged to get out of bed, sitting, walking on the spot, do regular short walks. This prevents stiffness, pressure ulcers, constipation and other complications. Patients are given a pair of surgical stockings that improve blood flow in the lower extremities and prevent blood clots.
For stitching wounds currently used surgical clips. Usually they are removed after about 10 days after the operation, it makes the physician. It requires regular dressing changes.
Food intake and fluid after surgery
Immediately after surgery are not allowed to eat or drink until the tissue heals. It may take several days.
Some patients (not all) establish a feeding tube during the operation. This tube (known as the nasogastric tube) is carried through the nose into the stomach. Sometimes there is a delay in gastric emptying after surgery, and this device can deliver a special liquid food into the body within a certain time. When the condition returned to normal, the patient is able to eat normally, the probe is removed.
Going to the toilet
During surgery a catheter installed into the bladder to drain urine. It will be removed as soon as the patient is able to get up and use the toilet. Before you start working intestine, it may take several days, and the first time may experience diarrhea.
Power after surgery for pancreatic cancer
After surgery for several days until the heal tissue powered nonstandard way. Then the patient is transferred to the gentle treatment and a few days later on a normal diet. Enzymatic doctor prescribes medications that help digest food.
What is a light diet?
As a rule, it is a soft, liquid and easily digestible food. An exemplary embodiment:
- Cereal, corn or rice flakes.
- Bread with butter.
- Apple or orange juice.
- Soup, bread and butter.
- Mousse, milk pudding.
- Bananas or fruit compote.
- Jelly, mousse or a yoghurt.
- Coated tablets, chewing marmalade, chocolate without nuts or dried fruits.
What to avoid:
- Spicy food.
- Fatty foods.
- Products that contain a large quantity of cheese (pizza or lasagna).
- Food, rich in fiber.
- Products with bones.
Should not drink carbonated drinks until the patient is on a light diet. They can cause bloating and reduce appetite. In some cases, provoke pain.
Sometimes patients require supplementation of dietary supplements with high protein content, as well as other species, to recover after surgery. Should not be without the knowledge of the physician to combine them with other means of reception, as this can interfere with the treatment.
Return to normal diet
It takes some time, so that after the operation the patient is back to normal. It is recommended to eat little and often, with a lot of small snacks and the use of high-energy drinks between meals.
During this period it is necessary to get enough energy and protein from foods, so you should try to use less watery soups, too many fruits and vegetables, and an excess of drinks during meals.
Recommended feeding program
Breakfast: porridge dish (you can add the cream / jam / honey), a glass of fruit juice.
Snack: a small piece of cake, coffee with milk.
- Omelet with whole milk and butter.
- Creamy soup with croutons and toast with butter.
- A thick, bold or yoghurt mousse to dessert.
Afternoon snack - cookies, a glass of milk.
Dinner: a small piece of meat with potatoes, rice or pasta; some vegetables; ice cream.
Snack before going to bed: a hot chocolate on the basis of milk, fruit juice, coffee and milk.
Some patients develop diabetes after these operations. It may be appointed as pills to control blood sugar or injecting insulin, which is produced by the pancreas.
The patient also referred to a specialist, which will be given recommendations on how to deal with the disease.
Potential complications after surgery for pancreatic cancer
The most serious complication after surgery and other types of Whipple's pancreatic surgery is anastomotic leak when new connection bodies do not heal properly and allow the contents to leak out. If this side effect occurs, you may need to stay in hospital longer than planned. As a rule, it does not require intervention, in rare cases - drainages and in exceptional circumstances - a second operation. Leakages from the pancreas can be serious because it produces digestive enzymes that can damage nearby tissue.
Delayed gastric emptying
Sometimes the stomach needs more time to adapt to the changes after surgery, and the food will not pass through it as needed. It may be necessary to stick to a liquid diet for a while or eating through a nasogastric tube, until the problem is solved.
Lymphatic fluid leak
Some patients after surgery in the abdominal cavity is observed leak latex or lymphatic fluid consisting of lymph and transformed into an emulsion of fats or fatty acids. This condition is treated by reducing the amount of food in a certain period of time. artificial kind of power can be used - a feeding tube.
Any surgery carries a risk of bleeding. Sometimes it takes a radiological procedure (embolisation) that blocks a vessel bleeding after surgery. In exceptional cases, to stop the bleeding is performed surgery.
The probability of infection
There is a risk of infection in the breast after surgery for pancreatic cancer, especially if the patient smokes. To minimize it, the physiotherapist will visit the patient after surgery, helping them and teaching the correct way to cough and breathe.
Problems with nutrient absorption process
After removing part of the pancreas patient may notice that his stools become pale, loose and greasy. This condition can be improved by taking drugs containing pancreatic enzymes. The doctor will give detailed information.
Most people are depressed after surgery, it can lead to being lost, frequent changes of mood. These emotions are part of the process when the patient tries to adjust. Psychologists Assuta hospital can provide expert help in this situation.