Having your operation for pancreatic cancer

Before your surgery, you will need

• Blood tests to check your general health and kidney function
• A chest X-ray to check your lungs are healthy
• Tests to check your heart is healthy (ECG, MUGA scan and echocardiogram)
• Tests to see how well your lungs work (Lung function tests)
• To learn breathing and leg exercises
• A detailed explanation of what to expect

You may have had some of these tests while your cancer was being diagnosed. You may need blood tests often because the balance of chemicals in your blood can change so quickly. It is important that your surgeon knows your blood chemical levels accurately, so these need to be up to date.

Your physiotherapist or nurse will teach you breathing and leg exercises. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to.

Breathing exercises will help to stop you getting a chest infection. And leg exercises will help to stop clots forming in your legs. Both these complications of surgery can happen because you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation. But this is major surgery, and you may have to stay in bed for the first few days.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

Remember - if you stop smoking before your operation, you will significantly reduce your risk of getting a chest infection after your surgery.

When you go into hospital for your operation, your surgeon, anaesthetist, physiotherapist and nurse will all come to talk to you about what will happen. Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic. Do ask as many questions as you need to. The more you know about what is going to happen, the less frightening it will seem. Don't worry if you think of more questions later. Just speak to your nurses. If they cannot answer your questions, they can contact the doctor to come and talk to you again.

If you are able to eat and drink, your surgeon may ask you to eat a special diet before your operation. This is to build you up for your surgery. You may be asked to eat a high calorie diet that contains lots of carbohydrate and protein, but is low in fat. This is because people with pancreatic disease find fat difficult to digest.

If you find eating and drinking difficult, your surgeon may ask you to come into hospital a few days before your surgery so that you can be given glucose and fluids through a drip. This makes sure you are not dehydrated before your operation.

If you have been finding it difficult to digest fats, you may have become deficient in vitamin K. Vitamin K helps the blood to clot, so your vitamin K levels need to be corrected before your surgery. This can be done by taking tablets, having injections, or through your drip, if you have one.

Lastly, if you have a hairy abdomen, you will need to be shaved before your operation. This is done because it reduces the risk of wound infection. You may have your shave in the operating theatre after you have had your anaesthetic.

If you have had very major surgery to try to cure your cancer, you will probably wake up in intensive care or a high dependency recovery unit. This is nothing to worry about. These are places where you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you will move back to the ward.

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

• Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
• Tubes into your neck and arms to measure your blood pressure
• One or more tubes coming out of your abdomen near your wound. These wound drains stop blood, bile and tissue fluid collecting around the operation site.
• A tube down your nose into your stomach (nasogastric tube) to drain it and stop you feeling sick
• A tube into your bladder (catheter) so that your urine output can be measured
• A fine tube into your back that goes into your spinal fluid (epidural) to help relieve pain

You may also have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse. Keeping your blood pressure stable is very important after surgery to the pancreas. So, your nurses will measure your blood pressure very often for the first week or so. At first, they can monitor it through the tubes that go into your neck and arms. These go directly into your main blood vessels and give a more accurate measurement than a blood pressure cuff on your arm would. Your nurses will also check your urine output because it can help to show whether you have too much fluid or are becoming dehydrated.

You may have a couple of electronic pumps attached to your drips. One of these might have painkillers in it. You may have a hand control with a button to press to give yourself extra painkillers, as you need them.

If you have had major surgery to your pancreas, you may have another pump containing insulin. It is important that your insulin levels are kept within the normal range. Your nurse will test your blood insulin every hour or two at first. The pump will be set to give you just the amount of insulin you need.

You may also have daily injections of blood thinning drugs, called anticoagulants, to help prevent blood clots from developing. There is information about blood clots in our question and answer section of CancerHelp UK.

You will almost certainly have pain for the first week or so. But there are many different painkilling drugs you can have. There are also different ways of having painkillers. You can have them by mouth or by injection. Doctors can also give anaesthetic drugs into your spinal cord - this is called an epidural.

It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly. If you have a button you can press to give yourself extra painkillers, do use it whenever you need to. You can't overdose because the machine is set to prevent that. Do tell your nurse if you need to press the button very often. You may need a higher dose in the pump.

After surgery to any part of the digestive system, the bowel often stops working for a while. Until it starts up again, you will not be able to eat or drink.

If you have been ill for some time before your surgery, you may be very run down and malnourished. This is because the pancreas produces enzymes that help us digest our food. You may need extra help with nutrition to start with. There are several ways you can have help with nutrition. You may have a white liquid called TPN through your drip. This stands for 'total parenteral nutrition'. It contains proteins, fats and carbohydrates that can be easily absorbed by the body. Or you may have liquid food through a tube that goes down your nose and into the stomach (a nasogastric tube). Or you may have a tube into your stomach or bowel through the wall of the abdomen. 

Once your bowel starts working again, you will be able to try sips of fluids. Gradually the amount you are allowed to drink will increase. And soon you will be able to try other fluids as well as water. Once you are able to drink without being sick, your drip and nasogastric tube can come out.

The wound from the operation will be covered up when you come round. It will be left covered for a couple of days. Then the dressings will be changed and the wound cleaned. The wound drains will be left in until they stop draining fluid. The bottles attached to them will be changed every day. Wound drains can usually be taken out about a week after your operation. This may be longer if there is any fluid leakage in the operation area. Your stitches will be left in for about 2 weeks.

Some surgeons leave a small tube (stent) inside you to help drain fluid from the pancreas after your surgery. This is usually removed about 3 weeks after the operation, so you have to come back to hospital to have it taken out in outpatients.

This may seem impossible at first. Moving about helps you to get better, but you will need to start very gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises.

Your nurses will encourage you to get out of bed and sit in a chair one or two days after your surgery. They will help you with all the drips and drains. Over the next couple of days, the tubes, bottles and bags will start to be taken out. Then, it will be much easier to get around and you will really feel that you are beginning to make progress.

After a few days you will be able to be up and about more. Gradually you will start to feel better. You will be able to eat more, but will have to stick to the diet that your dietician has planned for you. Your diet will be low in fat and quite bland. Frequent small meals are easier to manage than 3 large meals a day. There is more about diet after pancreatic surgery in the living with pancreatic cancer section of CancerHelp UK.

Your blood sugar will continue to be monitored until it is stable. Unless you have had a total pancreatectomy, you shouldn't need to be on insulin for long. If your blood sugar is not stable by the time you go home, you and your family will be taught how to keep an eye on it. There is more about this in the diet after pancreatic cancer section of CancerHelp UK.