Complications of Pancreatic Cancer Surgery:Patients Might Be Unaware

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Pancreatic resection is the only treatment option that can lead to a meaningful prolonged survival in pancreatic cancer and, in some instances, perhaps a potential chance for cure. With the advent of organ and function preserving procedures, its use in the treatment of chronic pancreatitis and other less common benign diseases of the pancreas is increasing. Furthermore, over the past two decades, with technical advances and centralization of care, pancreatic surgery has evolved into a safe procedure with mortality rates of <5%. However, postoperative morbidity rates are still substantial. This article reviews the more common procedure-related complications, their prevention and their treatment.

Anastomotic leak

By far the most important complication following a Whipple’s procedure or other Pancreatic Cancer surgery is where one of the anastomosis (the joins between either the bowel and the liver and pancreas) do not heal properly, allowing the contents to leak out.  If a leak does occur then you may need to stay in hospital longer than planned.  These leaks usually dry up.  Very rarely drains may need to be placed in the tummy and in exceptional circumstances, a second operation may be needed.  You might have an x-ray to ensure the drain is put in the right place. Sometimes leaks heal on  their own, but this takes time.  Leaks from the pancreas can be serious as the pancreas releases digestive enzymes which can damage nearby tissue.

Delayed emptying of the stomach

Sometimes your stomach may take longer to adapt to the changes after Pancreatic Cancer Surgery and your food may not be able to pass through efficiently. You may need to stick to a liquid-only diet only for a while.  Alternatively, you may need to take your nourishment through a naso-gastric tube (a feeding tube in the nose) until this resolves.

Chyle leak

Some patients may produce a milky type of fluid (chyle) into their abdominal drain Pancreatic Cancer Surgery.  Chyle is lymphatic fluid that can build up in the tummy following injury or surgery.  This is treated by reducing the amount of food you eat for a period of time. Your dietitian or surgeon may feel that you should have artificial feeding during this period, such as a feeding tube, to support your nutrition intake.

Bleeding

Any operation carries a risk of bleeding after Pancreatic Cancer Surgery.  A radiological procedure to block the bleeding vessel without operating (embolization) may be needed.  In exceptional circumstances an operation may be needed to control the bleeding.

Chest infections

It is possible to develop a chest infection following an operation, especially if you are a smoker. To minimise your risk, a physiotherapist will visit you after your operation to help you to cough and breathe properly.

Problems with food absorption

When you have had part of your pancreas removed, you may notice your stools (motions) have become pale, loose and greasy. You can correct this by taking a pancreatic enzyme capsule, which will help you to digest it.  Your medical team will tell you how and when to take these.

Feelings

Most people are overwhelmed after Pancreatic Cancer Surgery and this can lead to feelings of confusion and frequent changes of mood. These emotions are part of the process that many people go through in trying to come to terms with their illness. There may be times when you want to be left alone to sort out your thoughts and feelings. If you feel you need help in coping, do talk to your doctor or nurse.

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