Pancreatic cancer
Pancreatic cancer is a major concern for both patients and doctors, as it is difficult to diagnose and treat.
Surgical removal of tumors in the pancreas is a complex and demanding procedure, in which only a handful of surgeons are actually specialized.
This is the reason why tumors in the pancreas are often labeled inoperable, when in fact they can indeed be operated.
The most advanced and effective weapon in the of surgeons’ arsenal is Robotic Surgery.
Dr. Konstantinidis and his Surgical Team constitute an international Reference Center for the surgical treatment of pancreatic cancer with the help of a robotic system, having performed numerous pancreatic procedures with the highest levels of success and minimal complications.
Dr. Konstantinidis and his Surgical Team operate using the world’s leading robotic system, Da Vinci Xi, at Athens Medical Center.
What is the Pancreas?
The pancreas is a 15 cm long gland, located in the abdomen behind the stomach and in front of the spine. The pancreas plays an important role in body function, as it produces:
- digestive enzymes that help break down food
- hormones that allow the body to use and store the energy produced by the digestion of the food.
These hormones include insulin and glucagon, which are necessary for the control of glucose levels.
The anatomy of the Pancreas
The pancreas is pear-shaped with a wider section (the head), an intermediate (the body) and a narrow one (the tail).
It contains two types of cells:
- exocrine cells that produce digestive enzymes and
- endocrine cells, which secrete hormones directly into the bloodstream
Although malignancies (cancer) can develop from both cell groups, about 95% of pancreatic cancers derive from the exocrine part.
Why choose Dr. Konstantinidis?
Dr. K. M. Konstantinidis and his team possess vast experience in the field of laparoscopic and robotic surgery.
Dr. Konstantinidis is the pioneer of Robotic Surgery in Greece and one of the leading figures internationally in the field, having performed the largest series of General Surgery operations in Europe with the innovative Da Vinci® robotic system, including inguinal hernia surgeries.
What are the symptoms of Pancreatic Cancer?
These are often symptoms that can occur as a result of other conditions, as well.
Consult your doctor if you experience any of the above symptoms.
Signs and symptoms of pancreatic cancer may include:
jaundice (yellowing of the skin and of the white of the eyes)
pain in the upper and middle abdomen, as well as the back
unexplained weight loss
loss of appetite and
constant fatigue
What Causes Pancreatic Cancer?
There are many factors that can contribute to the development of pancreatic cancer, such as:
- a history of chronic pancreatitis
- smoking
- chronic diabetes mellitus
Also, some rare inherited diseases may be associated with pancreatic cancer.
Are There Different Types of Tumors in the Pancreas?
Pancreatic tumors are divided into those of the exocrine part and those of the endocrine part of the organ.
Also, they be distinguished according to where they are located, that is the head of the pancreas, body or tail.
Each type has its own characteristics and manifestations, requiring special tests for its diagnosis, responding differently to treatment options, and having different recovery prospects.
How is Pancreatic Cancer Diagnosed?
The earlier pancreatic cancer is diagnosed, the higher the chances of successful treatment and the better the prospects for the patient’s life expectancy.
However, diagnosing pancreatic cancer, especially at an early stage, is not an easy task since the disease is characterized by mild and common symptoms.
That is why clinical examination is not very helpful.
The most common tests for diagnosing pancreatic cancer are:
- Computed tomography of the abdomen
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic Ultrasound (EUS), through the stomach, which also allows for “biopsies” to be taken
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Intra-operative ultrasonography
EUS and ERCP are commonly used to substantiate imaging findings, while also contributing significantly to the detection of early cancers, mainly in the head of the pancreas, which where malignancies usually appear.
How is Pancreatic Cancer treated?
Appropriate treatment for pancreatic cancer is determined by the Oncology Board, an interdisciplinary team of physicians who take into account all available data, each one from the point of their own specialty.
The Oncology Board assesses the diagnostic data, the general state of health of the patient, the condition of the liver and pancreas, as well as various information concerning the tumor, and determines the appropriate treatment plan for each patient.
The main option for treating pancreatic cancer is the surgical removal of the tumor, usually assisted by chemotherapy and sometimes radiation therapy.
Chemotherapy can be combined with radiation therapy:
- before surgery to help in the shrinking of the tumor or
- after surgery to reduce the risk of relapse
- in patients with advanced pancreatic cancer as a means of delaying the progression of the disease and thus prolonging survival
Which types of Surgery are performed for the treatment of Pancreatic Cancer?
Treating pancreatic cancer is a great challenge because usually the diagnosis is not made in time, most patients do not have a detectable tumor and operations in the pancreas are generally complex and technically demanding.
That is why decisions about the surgical treatment of each patient must be made by surgeons who specialize in these operations, have extensive experience and high rates of successful tumor resection, even in patients who have previously been identified as inoperable.
The main types of surgery for the treatment of pancreatic cancer are the following:
- Distal (peripheral) pancreatectomy, for tumors in the body and tail of the organ
- Whipple’s procedure (pancreaticoduodenectomy), to remove tumors in the head of the pancreas
Depending on the case, the removal of tumors in the pancreas can be carried out with open surgery, laparoscopy or with the help of a robotic system, which is the most modern approach.
The laparoscopic method and robotic surgery (which is an evolution of the former) have significant advantages and are the first and optimal choice for performing the difficult and long pancreatic surgeries.
Both require small incisions of 5-7 mm, through which the surgeon can perform the operation endoscopically in its entirety. This significantly reduces blood loss, postoperative pain, visible scars as well as the risk of complications, while also minimizing the duration of hospitalization and the time required for the patient to recover.
Dr. Konstantinidis and his Surgical Team have extensive experience in laparoscopic and robotic pancreatic surgery with a long line of distal (peripheral) pancreatectomies and Whipple’s procedures.
They began robotic assisted operations on the pancreas in 2006 at Athens Medical Center using the then pioneering Standard da Vinci system, which was replaced in 2010 by the more advanced da Vinci Si HD.
Since 2019, robotic surgery on the pancreas is performed with the most modern system in the world, da Vinci Xi.
Distal (Peripheral) Pancreatectomy
What is Laparoscopic Distal (Peripheral) Pancreatectomy?
In cases where the tumor is located in the body or tail of the pancreas, it is removed with distal (peripheral) pancreatectomy.
The evolution of the laparoscopic method has allowed for performing this complex and difficult operation with the use of thin laparoscopic tools and through many tiny incisions, instead of the large incision of the classic open surgery.
Laparoscopic distal (peripheral) pancreatectomy is a minimally invasive technique and as such results in reduced blood loss, faster recovery of the patient and minimization of the risk of complications that occur after such a serious surgery.
Robotic Distal (Peripheral) Pancreatectomy
What is Robotic Distal (Peripheral) Pancreatectomy?
Robotic distal (peripheral) pancreatectomy includes all the advantages of the laparoscopic method and adds upon them.
Performing this demanding operation, which is often combined with the removal of the spleen (splenectomy), with the assistance of a surgical robotic system, minimizes the risk of complications often observed after pancreatic surgery, such as pancreatitis and pancreatic leak.
The state-of-the-art Da Vinci Xi robotic system, operated by Dr. Konstantinidis and his Surgical Team at Athens Medical Center, offer unsurpassed accuracy, stability and flexibility of surgical movements, allowing access to even the most inaccessible areas within the abdomen and ensuring that the tumor is removed with the least possible injury to the surrounding healthy tissue.
This is the reason why the robotic distal (peripheral) pancreatectomies performed by the Surgical Team of Dr. Konstantinidis are internationally renowned for their high success rates and extremely low complication rates.
What happens after Robotic Distal (Peripheral) Pancreatectomy?
After a robotic distal (peripheral) pancreatectomy, the patient usually remains in the hospital for 4 – 10 days (or 7-10 days after major surgery).
During his/her treatment the patient is closely monitored to ensure that there are no complications, such as pancreatitis and pancreatic leakage.
A few days after the operation, usually on the 5th day, the patient undergoes a computed tomography scan to determine his/her condition and recovery.
Following that, the feeding of the patient begins and if his course is considered satisfactory by his/her personal care team he/she can return home usually after the 7th day.
Whipple duodenal pancreatectomy
Whipple’s Procedure
What is Laparoscopic Whipple’s Procedure?
Whipple’s is the most common procedure to treat cancer in the head of the pancreas.
Also known as pancreaticoduodenectomy, it is a complex procedure to remove the head of the pancreas, a small terminal part of the stomach, the first part of the small intestine (duodenum), the gallbladder and the common bile duct.
After removing the above, the surgeon reconnects the other organs (anastomosis).
Some patients may be eligible for laparoscopic Whipple’s procedure. This involves the use of small laparoscopic instruments which are inserted into the tumor through several small incisions, as opposed to one but large incision required in open surgery.
In comparison to the conventional, open surgery, laparoscopic Whipple’s procedure is accompanied by less blood loss, less postoperative pain, shorter hospital stay, faster recovery and – most importantly – fewer complications.
Whipple’s robotic procedure
What is Robotic Whipple’s Procedure?
Whipple’s robotic procedure is an evolution of the same laparoscopic procedure carried out with the assistance of a robotic system.
Whipple’s is a difficult and demanding surgical procedure that involves serious complications risk. At the same time, it is a surgery that often proves to be a lifesaver for cancer patients.
Therefore, where surgically feasible, the best option is to perform robotic Whipple’s procedure.
In robotic Whipple’s procedure, the surgeon is seated on a console that allows him to view the surgical field magnified and in 3D, as well as to navigate the robotic arms with special control tools.
In turn, the surgical robot controlled by the surgeon also has very important advantages. Its flexible arms allow it to perform surgical maneuvers that are impossible for the human hand, with unparalleled precision and stability.
In addition, thanks to the surgeon’s ability to view the surgical field in great detail and magnification, the robotic arms can insert special, small surgical instruments into the patient’s body, in particularly narrow spaces and around corners, something impossible in open or standard laparoscopic surgery.
The aforementioned advantages guarantee minimizing the risk of serious complications, such as bleeding, spleen rupture, pancreatic leakage, and pancreatitis.
Especially in the critical phase of the anastomosis of the gastrointestinal tract after the removal of the tumor during Whipple’s surgery, the use of the robot proves to be lifesaving.
Indicatively, in large centers abroad, the most common complication after Whipple’s surgery, pancreatic leakage, appears in about 15% – 20% of all surgeries, while the corresponding percentage of the Surgical Team of Dr. Konstantinidis for this complication is restricted to just 5%!
What happens after Robotic Whipple’s Procedure?
Rehabilitation of the patient after robotic Whipple’s procedure requires 7 to 10 days of hospitalization, depending on the severity of the operation and the patient’s condition.
Hospital stay is mandatory for a period of time, as follow-up is required for a few days to ensure that there are no complications, such as pancreatitis and pancreatic leakage.
Usually, on the 5th day after the operation, the patient undergoes a computed tomography scan to determine his/her condition and recovery.
Following that, the feeding of the patients begins and if their course is considered satisfactory their personal care team they can return home, usually after the 7th day.
Pancreatic Tumor Enucleation
Enucleation is a surgical method applied in certain cases of neuroendocrine tumors of the pancreas, where it is determined that the removal of the duodenum is not necessary.
Neuroendocrine tumors, such as insulinoma, glucagonoma, gastrinoma, and VIPoma, are neoplasms that originate from neuroendocrine cells, which are widely distributed throughout the body.
They represent a small percentage of pancreatic tumors but grow more slowly than pancreatic cancer (adenomas) and, as such, are treatable, especially if diagnosed at an early stage when they are still very small.
In this case, enucleation is performed, which means the removal of only the tumor.
Enucleation is a surgical method that serves as an alternative to the Whipple procedure when neuroendocrine tumors are located in the head of the pancreas and to distal pancreatectomy when they are found in the body or tail of the organ.
Sometimes, the lymph nodes around the pancreas are also removed to check for the presence of cancer cells.
Enucleation can be performed through open surgery, which involves a large incision, or through a minimally invasive technique using a laparoscope and very small incisions in the abdomen.
The most minimally invasive approach involves robotic enucleation, which is the excision of the tumor with the assistance of a robotic surgical system (da Vinci Xi).
The use of the robot, with its renowned precision, stability, and flexibility provided by the robotic arms, minimizes damage to healthy tissues, which is the goal of enucleation, and reduces the risk of complications, such as rupture of adjacent organs and anatomical structures.
