Pancreatic Cancer Surgery in Kolkata

Key points

Painless jaundice, new-onset diabetes with weight loss, and back pain are important warning signs in adults over 50.
A pancreas-protocol CT decides the stage: resectable, borderline resectable, locally advanced or metastatic.
Chemotherapy before surgery is increasingly used, especially for borderline tumours.
Tumours in the head of the pancreas need a Whipple operation; body and tail tumours need a distal pancreatectomy with removal of the spleen.
Even after successful surgery, the cancer often returns — which is why chemotherapy is part of every curative plan.

Symptoms that should not be ignored

Painless jaundice with itching, pale stools and dark urine — typical of tumours in the head of the pancreas blocking the bile duct. See jaundice in adults.
Unexplained weight loss and loss of appetite.
Upper abdominal pain that goes through to the back, often worse lying flat — more typical of body and tail tumours.
New diabetes after 50, particularly with weight loss, or sudden worsening of long-standing diabetes.
Greasy, pale, floating stools (from poor digestion), nausea or early fullness.

Risk factors include smoking, long-standing chronic pancreatitis (including tropical calcific pancreatitis, covered on our pancreatitis page), obesity, diabetes and a family history of pancreatic cancer or certain inherited syndromes.

CA 19-9, pancreas-protocol CT and the other tests

1
Pancreas-protocol CT
A contrast CT done in specific phases with thin slices, designed to show the tumour's contact with the superior mesenteric artery, coeliac axis, hepatic artery and portal/superior mesenteric vein. An ordinary abdominal CT often does not give enough detail — repeating it properly is common and worthwhile.
2
CA 19-9 blood test
Useful as a baseline and to track response, but not a screening test. It is falsely raised by jaundice and cholangitis, and around one in ten people cannot make CA 19-9 at all, so a normal value does not exclude cancer.
3
Endoscopic ultrasound (EUS) with biopsy
Confirms the diagnosis when chemotherapy is planned first. For a clearly resectable tumour, a biopsy is not always required before surgery.
4
Chest CT, and PET-CT or MRI liver when needed
To look for spread to the lungs or small liver deposits that change the plan.

The four categories that decide treatment

Categories follow widely used international definitions; the exact criteria are applied by the multidisciplinary team.
Category	What the scan shows	Usual plan
Resectable	No contact, or minimal contact, with the major arteries and veins; no spread	Surgery, then chemotherapy (chemotherapy first is also increasingly used)
Borderline resectable	Limited contact with the portal/mesenteric vein or arteries that may still allow removal	Chemotherapy first (often 2–4 months), re-scan, then surgery if the tumour responds or stays stable
Locally advanced	Encases the main arteries; no distant spread	Chemotherapy, sometimes radiotherapy; a minority become operable
Metastatic	Spread to the liver, lungs or abdominal lining	Chemotherapy and supportive care; surgery does not help

Giving chemotherapy first (neoadjuvant therapy) has two advantages: it treats cancer cells that may already have spread invisibly, and it reveals aggressive tumours that progress quickly, sparing those patients a major operation that would not have helped.

Which operation for which part of the pancreas

Head of pancreas — Whipple

About two-thirds of pancreatic cancers arise in the head. The Whipple operation (pancreaticoduodenectomy) removes the pancreatic head, duodenum, lower bile duct and gallbladder, and then reconnects the pancreas, bile duct and stomach to the intestine.

Body or tail — distal pancreatectomy

The left part of the pancreas is removed, usually with the spleen and surrounding lymph nodes. There is no reconnection. It can often be done laparoscopically or robotically in suitable patients. Vaccinations are given because of the spleen removal.

Whole gland — total pancreatectomy

Needed only rarely, when the tumour extends throughout the pancreas. It leaves the patient with insulin-dependent diabetes and lifelong enzyme replacement, so it is reserved for situations where lesser surgery cannot clear the cancer.

When the tumour touches the portal or superior mesenteric vein, a segment of the vein can be removed and reconstructed during the operation. Arterial resection is far more selective and considered only in specialised settings.

Preparing for surgery

If jaundice is deep, or chemotherapy is planned first, the bile duct is drained with a stent placed at ERCP — ideally after the pancreas-protocol CT has been done. Nutrition is optimised, diabetes controlled, and heart and lung fitness assessed. Patients who smoke should stop immediately; walking daily before surgery helps recovery.

Survival: an honest picture

Only around 15–20% of patients are suitable for surgery at diagnosis. For those who complete surgery and chemotherapy, large published series report five-year survival in the range of roughly 20–30%, with better results for small tumours with clear margins and no lymph node involvement. Recurrence within the first two to three years is common. For locally advanced and metastatic disease, modern chemotherapy extends life and controls symptoms, but cure is rare.

Not every pancreatic tumour is this cancer

Neuroendocrine tumours, cystic tumours such as IPMN, and periampullary cancers (ampulla, distal bile duct, duodenum) behave differently and often have a much better outlook after surgery. The exact diagnosis matters.

Seeking an opinion in Kolkata

Dr Bappaditya Har performs pancreatic surgery, including Whipple and distal pancreatectomy, at Narayana RN Tagore Hospital, Mukundapur, and works with medical oncologists and radiologists on each plan. Send your CT scans (with the images on CD or a link), CA 19-9 and blood reports on WhatsApp at +91 70420 39420 before travelling; for appointments call 080675 06860. More on his wider HPB surgery practice.

Frequently asked questions

Is pancreatic cancer curable?

It can be cured in a minority of patients whose tumour is removed completely and who also receive chemotherapy. Most patients are diagnosed at a stage where cure is not possible, but treatment can still extend life and control symptoms.

What CA 19-9 level means cancer?

There is no single cut-off. CA 19-9 is raised by jaundice, infection and other conditions, and some people with cancer have normal levels. It is interpreted together with the CT scan, not on its own.

Why do I need chemotherapy before surgery?

For borderline and some resectable tumours, chemotherapy first treats hidden spread, can shrink the tumour away from blood vessels, and identifies fast-growing cancers for which surgery would not help.

Is a biopsy necessary before pancreatic surgery?

Not always. If the scans show a typical resectable tumour, surgery may proceed without one. A biopsy is required before starting chemotherapy.

Which surgery is done for pancreatic cancer?

A Whipple operation for tumours in the head of the pancreas, a distal pancreatectomy for the body and tail, and rarely a total pancreatectomy when the whole gland is involved.

Can pancreatic cancer surgery be done laparoscopically?

Distal pancreatectomy is often done laparoscopically or robotically in suitable patients. Minimally invasive Whipple is performed at some centres, but open surgery remains standard for many cases, especially after chemotherapy or with vein involvement.

Pancreatic Cancer Treatment and Surgery in Kolkata