You will undergo a thorough medical evaluation to assess your readiness for surgery. This usually includes ultrasound, x-ray, computed tomography (CT) scans, and/or endoscopic retrograde cholangiopancreatogram (ERCP), which visualizes the bile ducts and pancreas. You may also undergo an angiography to assess blood flow to the pancreas as well as a needle biopsy of the tumor to test whether it is benign or malignant. All these tests help the doctor diagnose your condition correctly to develop the most appropriate treatment plan.

Most patients with pancreatic cancer have poor appetites and become malnourished, requiring intravenous nutrition before the surgery. Some may need to undergo chemotherapy and/or radiation before or after the procedure for the best results from the surgery. (Some patients may not be suitable candidates for surgery, but the doctor may reconsider this if the patient responds well to chemotherapy and/or radiation.) Sometimes radiation may be done during surgery to improve survival rates, but it is currently not widely done.

For patients undergoing distal pancreatectomy, where the spleen is also removed, the doctor may prescribe antibiotics before the surgery to decrease the chances of infection.

1.    Keep all follow-up appointments with the doctor. Patients usually see their doctor approximately 1-2 weeks after the surgery to check on recovery and receive the results of any biopsies done. The doctor will go over any additional treatment options available, such as chemotherapy or radiation. The patient will be referred on to a medical oncologist or radiation oncologist as appropriate.

2.    After treatment, patients must be monitored for a long time. Initially blood tests and x-rays are done every 2-3 months for the first couple of years. Then visits are 6 months apart until 5 years are completed. After that follow-up appointments are once a year.

3.    Get at least 6-8 hours of sleep each day and exercise moderately starting 2-4 weeks after surgery, such as by walking around the house for 15-30 minutes each day.

4.    Avoid lifting heavy objects because this can impact the surgical incision due to increased pressure within the abdomen. Certain intense activities can be started approximately 3 months after surgery. Be sure to check with the doctor first.

5.    Follow all instructions of the medical team after being discharged from the hospital and see the doctor immediately if you experience any of the following:

·        Fever.

·        Pain at the surgical site that does not improve after rest or medication.

·        Incision is red, swollen, or leaking discharge.

·        Uncontrolled bleeding from the incision.

·        Pain or tightness in the chest and difficulty breathing, and symptoms worsening with time.

·        Inability to eat, weight loss.

·        Yellowing of skin or eyes.

·        The most common complication of surgery is leakage where the organs are sutured to each other, infection, and excessive bleeding. These complications can usually be treated by placing drains and taking antibiotics. In some cases, additional surgery may be required.

·        After surgery, most patients have a difficult time eating or feel nauseated or vomit or experience a burning or tightness in the chest due to the stomach temporarily not functioning. The digestive system will return to normal in a few weeks or can take a few months. The doctor cannot predict when the stomach will return to normal and the patient will have to continue to experiment until their eating returns to normal.

·        Some patients may need to change their eating habits permanently to prevent diarrhea, gas, and abdominal pain.

·        If the stomach does not return to normal, the patient may require tube feeding to receive adequate nutrition. Generally, during the recovery period from a pancreatectomy, patients should eat small meals several times a day, ideally every 3 hours. Each meal should consist of protein to maintain muscle mass. Drink plenty of water between meals to prevent dehydration.

• Before traveling for treatment, if the patient is taking anticoagulant/blood thinner medications, please let the doctor know as it might have to be discontinued.
• Travelers to Thailand should plan to stay in the country for at least 2-3 weeks or for the entire duration of treatment.
• If the patient plans to return home after the procedure, please discuss the plan with a doctor before travel arrangement. There are no restrictions for air travel.
• Patient will be receiving a physical check and wound care on the appointment date, including treatment record, and Fit to Fly document (if needed to present before flying).

The success of this procedure depends on many factors, including the patient’s health and their behavior before and after the surgery. Please discuss the likelihood of success with the doctor before the procedure.

What if the procedure is not performed?

Pain will worsen and interfere with daily life. In the cancer of cancer, it can metastasize to other parts of the body and lead to life-threatening complications.

Pancreas transplantation may be an option for some patients. Please discuss all possible treatment options with the doctor.