Dr. Abhishek Jain

MBBS, MS (General Surgery)
FAMAS(Italy), FAAOS(Italy)
FICS (GI Surgery), FISCP (Colo Proctology)
Colorectal Surgery,Advance Laparoscopic Surgery,
Abdominal Oncology Surgery, Bariatric & Metabolic Surgery

Breast Cancer: Surgery

Surgery is a common treatment for breast cancer. It’s done to remove as much of the cancer as possible. Women have many surgical options. The type of surgery done depends on:

• The size and location of the breast lump or tumor

• The type the breast cancer

• If the cancer has spread within the breast or has spread outside of the breast to the lymph nodes, or to other parts of the body

• The size of the breast

• The woman’s preference

There are several types of breast surgery. The main types include:

• Breast-conserving surgery

• Mastectomy

• Sentinel lymph node biopsy

Breast-conserving surgery

This type of surgery is also called breast-sparing surgery, lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. The surgeon takes out only the cancer lump and an edge (margin) of healthy tissue around it. The breast itself remains intact.

Radiation therapy is often given after breast-conserving surgery to destroy cancer cells that may not have been removed during surgery. In some cases, chemotherapy and radiation are both given after breast-conserving surgery.

Breast-conserving surgery is a treatment option for some women with small breast cancer that hasn’t spread. Studies have shown that women who have breast-conserving surgery then radiation have similar survival rates as those who have mastectomy. Many women prefer this type of surgery instead of having their whole breast removed.

There are 2 main types of breast conservation (tissue-sparing) surgery. These include a lumpectomy and a partial (segmental) mastectomy.

A lumpectomy is the removal of the breast cancer and a portion of normal tissue around the breast cancer lump. The areas removed during the surgery are shaded in green. The surgeon may also remove some of the lymph nodes under the arm to see if the cancer has spread. The lymph nodes under the arm (axillary lymph nodes) drain the lymphatic vessels from the upper arms, most of the breast, the neck, and the underarm areas. Often, breast cancer spreads to these lymph nodes. It then enters the lymphatic system, and spreads to other parts of the body. Radiation therapy is often given after a lumpectomy. This is to kill cancer cells that may not have been removed during the lumpectomy.

A partial (segmental) mastectomy removes the breast cancer and a larger portion of the normal breast tissue around the breast cancer. The areas removed during the surgery are shaded in green. The surgeon may also remove some of the lymph nodes under the arm. The lymph nodes under the arm (axillary lymph nodes) drain the lymphatic vessels from the upper arms, most of the breast, the neck, and the underarm areas. Often, breast cancer spreads to these lymph nodes. It then enters the lymphatic system, and spreads to other parts of the body. Radiation therapy is often given after a partial mastectomy. This is to kill cancer cells that may not have been removed during the partial mastectomy.

Mastectomy

Mastectomy is surgery to remove the breast. The doctor may advise a mastectomy for a woman who has any of the below:

• Cancer that has spread to other parts of the breast tissue or has spread to the lymph nodes under the arm

• A finished course of radiation therapy to the affected breast or chest area

• 2 or more areas of cancer in the same breast that are too far apart to be removed with one incision

• Breast that is very small and tumor that is large

• Inflammatory breast cancer

• Connective tissue disease(s) that are sensitive to radiation therapy

• A current pregnancy, so radiation normally needed after breast-conserving surgery could harm the unborn baby

• Some tumor left over from previous breast-conserving surgery

There are 3 types of mastectomy. Your doctor can explain the benefits and risks of each type:

• Total (or simple) mastectomy. This type removes the whole breast and often the lining over the chest muscle.

• Modified radical mastectomy. This type removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. Sometimes the doctor has to remove 1 of the 2 chest muscles.

• Radical mastectomy. This is also called a Halsted radical mastectomy. This done in very rare cases. For this surgery, the surgeon removes the whole breast, all of the lymph nodes under the arm, the lining over the chest muscles, and both of the chest muscles under the breast.

A skin sparing method may be an option for some women planning to have reconstruction surgery at the same time as the mastectomy. This is called immediate breast reconstruction. In this surgery, most of the skin over the breast except the nipple and areola is left intact. The same amount of breast tissue under the skin is removed as with a total mastectomy.

During a total (or simple) mastectomy, the surgeon removes the entire breast. This includes the nipple, the areola, and most of the overlying skin. The areas removed during the surgery are shaded in green. The surgeon may also remove some of the lymph nodes under the arm to see if the cancer has spread. The lymph nodes under the arm (axillary lymph nodes) drain the lymphatic vessels from the upper arms, most of the breast, the neck, and the underarm areas. Often, breast cancer spreads to these lymph nodes. It then enters the lymphatic system, and spreads to other parts of the body. During a total (or simple) mastectomy, the surgeon removes the entire breast. This includes the nipple, the areola, and most of the overlying skin. The areas removed during the surgery are shaded in green. The surgeon may also remove some of the lymph nodes under the arm to see if the cancer has spread. The lymph nodes under the arm (axillary lymph nodes) drain the lymphatic vessels from the upper arms, most of the breast, the neck, and the underarm areas.

Often, breast cancer spreads to these lymph nodes. It then enters the lymphatic system, and spreads to other parts of the body.
A skin-sparing mastectomy removes the same amount of breast tissue but leaves most of the skin, except for the nipple and areola. This may be an option if immediate breast reconstruction will be done.

During a radical mastectomy, the surgeon removes the entire breast. This includes the nipple, the areola, and the overlying skin. The surgeon also removes some of the lymph nodes under the arm (axillary lymph nodes), and the chest muscles. The areas removed during the surgery are shaded in green. For many years, this was the standard operation. A radical mastectomy is now rarely done and is only advised when the breast cancer has spread to the chest muscles.

Sentinel lymph node biopsy

If breast cancer spreads, it usually spreads first to the lymph nodes under your arm (axillary lymph nodes). Lymph nodes are small bean-shaped organs. They drain fluid from the breast area, upper arms, the neck, and underarm area. When breast cancer spreads to these lymph nodes, enters the lymphatic system, and spreads to other parts of the body.

The sentinel lymph node is the node the cancer reaches first. For this surgery, a specially trained surgeon injects a radioactive substance or dye near the tumor. The dye travels to the sentinel node. The node can then be found and removed. It’s then sent to a lab to see if it has cancer cells in it. In some cases, there can be more than 1 sentinel lymph node. If the sentinel node doesn’t have cancer, then it’s likely that the rest of your underarm nodes don’t have cancer. Your doctor may opt not to remove other underarm tissue and lymph nodes. Having your underarm lymph nodes removed isn’t a dangerous surgery. But it can lead to side effects, such as numbness due to nerve damage and a lifelong risk of swelling in your arm and chest (lymphedema).

Sentinel lymph node biopsy is a complex surgery. If your doctor thinks you should have this type of biopsy, ask how much experience the surgical team has in the surgery.

This kind of biopsy can save you from having the rest of your nodes taken out. Sentinel node biopsy is often followed by breast-conserving surgery or a mastectomy. This biopsy may be scheduled for the same time as breast-conserving surgery, or it can be done separately.

Risks of breast cancer surgery

All surgery has some risks. The risks of breast cancer surgery include:

• Hard tissue in the breast due to scarring at the incision site

• Wound infection or bleeding

Breast-conserving surgery may cause:

• Temporary swelling of the breast (breast-conserving surgery only)

• Change in breast size and shape (for breast-conserving surgery only)

• Clear fluid trapped in the wound (seroma) that may need to be drained and treated with compression or an injection

A risk of lymph node removal is swelling of the arm (lymphedema). This can cause:

• A feeling of tightness in the arm

• Pain

• Redness

• Decreased flexibility of the arm, hand, and wrist

There may be other risks depending on your overall health and the type of surgery done. Talk with your healthcare provider about any concerns or questions you have about your risks.
Questions to ask your doctor before surgery

Your healthcare team will talk with you the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:

• What type of surgery will be done

• What will be done during surgery

• The risks and possible side effects of the surgery

• If the surgery will leave scars and what they will look like

• How your breast or chest will look after surgery

You may also want to ask your doctor other questions, such as:

• Which type of surgery do you advise for me? Why?

• Where will the cut (incision) be? How much breast tissue will be removed?

• Will any lymph nodes be removed?

• Will I be able to have breast reconstruction if I have a mastectomy?

• Do you advise breast reconstruction to be done at the same time of the mastectomy? Or should it be done at a later date?

• Will I need more treatment after surgery, such as radiation or chemotherapy?

• What type of follow-up care will I need?

• When can I go back to my normal activities?

Getting ready for your surgery

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. This is the doctor in charge of the medicine that helps you sleep and feel no pain during surgery. You can ask questions about the anesthesia and how it will affect you.

After your surgery

You may have to stay in the hospital for a few days, depending on the type of surgery you had. It can also depend on what your insurance will cover. You may want to talk with your insurance company before your surgery.

Your healthcare providers will explain the side effects you can expect with each type of surgery. They can also suggest ways to help prevent or manage these side effects. It is important that you let your healthcare provider know if you have side effects.

After surgery you may have:

• Pain. For the first few days after surgery, you are likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, you may not want to cough or move, which you need to do as you recover from surgery.

• Tightness in your skin. The skin near your breast may feel tight. Sometimes your arm and shoulder muscles will feel stiff, too.

• Fatigue. You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person, but this usually gets better with time.

Recovering at home

When you get home, you may get back to light activity, but you should avoid strenuous activity for 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover.
After breast cancer surgery, you will have a bandage, also called a dressing, over the place where you had surgery. It is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. If adhesive strips are used, they should be kept dry. They will fall off within a few days.
You may also have tubes in your chest. These are called drains. These are to remove blood and fluids that build up during the healing process. You may have to empty and measure the fluid. Your healthcare team will tell you what problems to look for and tell them about. The drains stay in place for about 2 weeks, or until only a small amount of fluid is draining.

Your doctor or nurse will give you written instructions on how to care for your incision, change your bandage, and drain and check the fluid. You’ll also be told when to call your doctor or nurse about a problem. You should study the instructions and share them with your caregiver, if you have one. Be sure you know how to get in touch with your doctor after hours and on weekends, too.

You may be told to start postmastectomy exercises the day after your surgery, or at a later time. These exercises may include doing things like flexing your fingers and touching your hand to your shoulder. Ask if there are any exercises or activities you should avoid to prevent swelling.

Losing one or both of your breasts can be emotionally difficult. After surgery, you and your spouse or partner should take the time to talk about how you feel. You may feel that you need counseling. Ask your healthcare provider for the names and locations of support groups or counselors if you feel you need one.
Possible complications after surgery
After surgery, you may have any of the below. Talk with your healthcare team if you need help.

• Stiffness in your underarm after lymph node removal. Gentle exercises and massage therapy can help with stiffness. You should avoid hair removal creams, strong deodorants, and shaving under your arm for about 2 weeks after surgery.

• Lack of feeling in the skin on your breast or upper arm. When your breast is removed, nerves must be cut. This may cause short-term numbness. Usually, most of the feeling returns within 1 to 2 years after surgery.

• Phantom breast sensations. You may feel like your breast is still there. People who lose limbs often have this feeling, too. The feeling usually goes away over time.

• Shift in weight or feeling off-balance. If you had large breasts, losing one or both of them can make you feel off-balance and make your neck or back hurt. This usually gets better as you adjust to the changes in your body.

• Constipation. You may have constipation from using some pain medicine, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or the use of a stool softener.

• Lymphedema. If you’ve had your underarm lymph nodes removed, you may have swelling in your chest, arm, and hand on the side where you had surgery. While this is normal right after surgery, it can later become a long-term problem. Be sure you understand what to watch for and what to do to help keep this from happening.

• Infection. Although not common, infection is a risk whenever you have surgery. Tell your healthcare provider if you have any swelling, redness, warmth, drainage, fever, or sudden pain.
Follow-up care

Your doctor will tell you when to return for a follow-up visit. During this visit, he or she will check the incision and remove stitches if needed.

You may need radiation treatment after surgery. Your healthcare provider will talk with you about this type of treatment.

When to call your healthcare provider

Let your healthcare provider know right away if you have any of these problems after surgery:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Fever

• Chills

Cholecystectomy

You’ve had painful attacks caused by gallstones. To treat the problem, your healthcare provider wants to remove your gallbladder. This surgery is called cholecystectomy. Removing the gallbladder can relieve pain. It will also prevent future attacks. You can live a healthy life without your gallbladder. You may also be able to go back to eating foods you enjoyed before your gallbladder problems started.
Before your surgery

Be prepared:
• Tell your provider what medicines you take. Include those bought over the counter. Also include herbs or supplements. Be sure to mention if you take prescription blood thinners. This includes warfarin, clopidogrel, and aspirin.

• Have any tests your provider asks for, such as blood tests.

• Don’t eat or drink after midnight, the night before your surgery. This includes water, coffee, and mints. However, you may need to take some medicine with sips of water—talk with your healthcare provider.
The day of surgery

When you arrive, you will prepare for surgery:

• An IV line will be put into a vein in your arm or hand. This gives you fluids and medicine.

• An anesthesiologist will talk with you about anesthesia. This is medicine used to prevent pain. You will receive general anesthesia. This puts you into a state like deep sleep through the procedure.
During surgery

There are 2 methods for removing the gallbladder. Your healthcare provider will choose which method is best for you:

• Laparoscopic cholecystectomy. This is most common. During surgery, 2 to 4 small incisions are made. A thin tube with a camera is used. This is called a laparoscope. The scope is put through one of the incisions. It sends images to a video screen. Surgical tools are put through other incisions. The gallbladder is removed using the scope and these tools.

• Open cholecystectomy. One larger incision is made. The surgeon sees and works through this incision. Open surgery is most often used when scarring or other factors make it a better choice for you.
In some cases, safety requires a change from laparoscopic to open surgery during the procedure.
After surgery

You will be sent to a room to wake up from the anesthesia. You will likely go home the same day. In some cases, an overnight stay is needed. If you had open cholecystectomy, you may need to stay in the hospital for a few days. When you are released to go home, have a family member or friend ready to drive you.
Risks and possible complications of gallbladder surgery

All surgeries have risks. The risks of gallbladder surgery include:

• Bleeding

• Infection

• Injury to the common bile duct or nearby organs

• Blood clots in the legs

• Bile leaks

• Hernia at incision site

• Pnemonia

Liver Cancer: Surgery

Surgery offers the best chance to cure liver cancer. But only a small portion of people with liver cancer can have surgery. Different kinds of surgery may be done. Which type you have depends on the size of the cancer, where it is, how much it has spread, how well the rest of your liver is working, and other factors.

When might surgery be used for liver cancer?

Surgery is often the treatment of choice if it can be done. But surgery may not be a choice if you have cirrhosis or other liver problems and don’t have enough healthy liver. Surgery is not a choice if the cancer has spread outside the liver to other parts of the body. You might be a candidate for surgery if:

• Your cancer is in only one part of the liver and is not in a major blood vessel. The rest of your liver must be fairly healthy, and you must be otherwise healthy enough to have major surgery. In this case, you might be able to have surgery to remove the part of the liver containing the tumor. This is called a hepatectomy.

• Your cancer is only in the liver, but it is too large or in too many places. Or the rest of your liver is not healthy enough for a hepatectomy. You may be able to have surgery to remove the entire liver, followed by a liver transplant.

Types of surgery for liver cancer

Below are options for liver cancer surgery.
Hepatectomy (partial hepatectomy or tumor resection)
The surgeon removes the part of the liver that contains the tumor. It is often the preferred surgery if it can be done. But not many people with liver cancer can have this surgery. This is because the cancer has grown too large or is in many parts of the liver, or because the rest of the liver isn’t healthy enough for the person to withstand surgery. The surgeon usually will use a long cut (incision). But some doctors now do it laparoscopically. In this approach, the surgeon makes several small incisions in the abdomen. He or she uses long, thin surgical tools to remove part of the liver. One of these tools (laparoscope) has a tiny video camera on the end to let the surgeon see inside the abdomen.

Liver transplant

The surgeon removes the entire liver and replaces it with part or all of a liver from a donor. More people might be able to have this type of surgery, but its use is limited because it can be hard to find a donor liver for transplant.

Possible risks, complications, and side effects of surgery

Surgery for liver cancer is a major operation, so it’s important that you are healthy enough for it and that the doctor thinks the possible benefits outweigh the risks. All surgery has risks. Some of the risks of any major surgery include:

• Reactions to anesthesia

• Blood clots in the legs or lungs

• Damage to nearby organs

• Pneumonia

Other risks from liver surgery

Along with the risks above, liver surgery can sometimes cause these problems:

• Excess bleeding. Bleeding is a risk with any type of surgery, but this risk can be even higher with liver surgery. This is because a lot of blood passes through the liver. The liver also makes clotting factors that normally help stop bleeding, and surgery can also affect this.

• Infection. This is especially a concern in people who get a liver transplant. This is because they need to take medicines to suppress their immune system to keep it from rejecting the donor liver. Infections in people taking these medicines can be very serious. The medicines themselves can also have their own side effects.

• Rejection of the donor liver. Even though people who have had a liver transplant take medicines to suppress their immune system, sometimes the body might still reject the new liver.
Getting ready for your surgery

Before you go for surgery, you will meet with your surgeon to talk about the procedure. At this time, you can ask any questions and discuss any concerns you may have. This is also a good time to review the possible side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you have discussed all the details with the surgeon, you will sign a consent form that says that the doctor can do the surgery.

You may be told to stop taking certain medicines a few days before the surgery. You may also be told to follow a special diet.

What to expect during surgery

When it is time for your surgery, you will be taken into the operating room. Medical staff will place an IV (intravenous) line in your arm. Medical staff will watch your heart rate, blood pressure, breathing, and other vital signs during the surgery. You will be given medicine to make you sleep through the surgery so you will not feel any pain.

What your surgeon removes and where he or she makes the incisions depends on the type of surgery you have. And that is based on where the tumor is.

After your surgery is complete, medical staff will move you to the recovery room. Staff will monitor you for another hour or two. Once you are awake and stabilized, the staff will move you to the regular hospital floor.

What to expect after surgery

When you first wake up, you might have some pain. Your doctor or nurse will give you pain medicine as needed for a few days to help you feel more comfortable. The pain medicine will also help you get up and walk the day after your surgery. Walking is important for your recovery.

It will take you time to get back to eating normally and having regular bowel movements. You may have to stay in the hospital for at least several days. How long you stay will depend on the type of surgery you have. People who have a laparoscopic hepatectomy can often go home sooner than those who have an open hepatectomy. This is because they have smaller incisions that can usually heal faster.

You can gradually return to most normal activities once you leave the hospital. But you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your doctor or nurse.

After surgery, you may feel weak or tired for a while. The amount of time it takes to recover from an operation is different for each person. But you will probably not feel like yourself for several months. You likely won’t be able to drive for a while, as directed by your healthcare providers.

Surgical Breast Biopsy: Types of Biopsies

A surgical breast biopsy requires an incision in the skin. This allows your doctor to take a large sample of tissue from the breast. In fact, the whole lump is often removed. The sample is then sent to a lab for study.

Open surgical biopsy

Open surgical biopsy removes a tissue sample through a skin incision. To keep you from feeling pain during the biopsy, you are likely to be given intravenous (IV) sedation. This produces a light sleep and you don’t feel the surgery. Your surgeon then makes one incision in your breast. If possible, this is done in a way that hides the scar. In most cases, all of the lump is removed. The incision is closed with stitches. Some stitches dissolve on their own. Others may need to be removed when the incision heals.

Wire localization

A lump that can’t be felt may be hard to locate. In such a case, a mammogram or ultrasound is used to locate the area. One or more thin guide wires may be placed in your breast before biopsy surgery to mark the tissue that is to be removed. Then you’re taken to the operating room for surgery. The wire is removed during the biopsy.

Esophageal Cancer: Surgery

Surgery can sometimes be used to treat esophageal cancer. Different kinds of surgery may be done. The type you have depends on where the cancer is, how much it’s spread, and other factors.

When might surgery be used for esophageal cancer?

Surgery is often used to treat early stage esophageal cancer, especially cancer in the lower part of the esophagus. It’s often used along with other treatments. These can include radiation therapy and chemotherapy.

Types of surgery for esophageal cancer

Esophagectomy/esophagogastrectomy

The main surgery used to treat this type of cancer is esophagectomy. In this procedure, the surgeon removes part or all of your esophagus. He or she also takes out nearby lymph nodes to check them for cancer. For cancers in the lower part of the esophagus, some of the stomach might be removed as well. This is called an esophagogastrectomy. The pieces of the esophagus or stomach that are left are then reconnected. If there isn’t enough esophagus left to reconnect the ends, the surgeon might use a section of intestine to bridge the gap.

This type of surgery can be done in two ways:

• In one approach, the surgeon makes cuts in your neck, chest, and/or abdomen to remove the esophagus. Where the cuts are made depends on where the cancer is.

• In a newer approach, the surgeon operates through smaller incisions. He or she uses long, thin surgical tools. This approach is used only for smaller tumors. But because the cuts are smaller, people may recover from it more quickly.

Both approaches are complex. It’s important that the surgeon has a lot of experience.

Palliative surgery

For more advanced cancers, sometimes other, less complex surgery is done. This can help with problems, such as trouble eating. For instance, you may have a minor procedure. In it, your surgeon will put a feeding tube through your skin and into the stomach or small intestine.

Possible risks, complications, and side effects of surgery
All surgery has risks. Some of these risks include:

• Reactions to anesthesia

• Heavy bleeding

• Blood clots in your legs or lungs

• Damage to nearby organs

Risks from esophageal surgery

Along with the risks above, esophageal surgery can sometimes cause problems. These can include:

• Pneumonia. Some people have lung problems after surgery. This can lead to pneumonia.

• Anastomotic leak. After the surgeon removes a part of the esophagus (or the esophagus and stomach), he or she attaches the two ends together. A leak can occur at this connection. You might need surgery to fix this.

• Esophageal stricture. Part of the esophagus might become narrower. This can cause problems swallowing.

• Problems eating. After surgery, contents from your stomach might enter the esophagus more easily. This could lead to problems such as heartburn, nausea, and vomiting.

Getting ready for your surgery

Before you go for surgery, you’ll meet with your surgeon to talk about it. At this time, ask any questions and share concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you have discussed all the details with the surgeon, you’ll sign a consent form that says that he or she can do the surgery.
A few days before your surgery, your healthcare provider might give you laxatives and enemas to help clean out your colon. He or she will tell you when and how to use these. You may also be told to follow a special diet.

On the day of your surgery, you should arrive at the hospital admission area a couple of hours before the time your surgery is set to start. There, you’ll complete the needed paperwork and go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time, your healthcare team will ask you about your health history. They’ll also ask about medicine allergies and talk about the procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.

While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist will do an evaluation. He or she will also explain the anesthesia you’ll have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won’t feel any pain. Be sure to answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have about your anesthesia. You will sign a form that states that you understand the risks involved.

Your surgeon will also see you in the preoperative area. You can ask any last-minute questions you have. This will help put your mind at ease.

What to expect during surgery

When it’s time for your surgery, you’ll be taken into the operating room. There will be many people there. These include the anesthesiologist, surgeon, and nurses. Everyone will be wearing a surgical gown and a face mask. Once in the room, someone will move you onto the operating table. There your anesthesiologist or nurse will place an intravenous line (IV) into your arm. This requires just a small skin prick. Someone will place special stockings on your legs to help prevent blood clots. EKG wires with small, sticky pads on the end will be attached to your chest. This is done to monitor your heart. You’ll also have a blood pressure cuff wrapped around your arm. When all the preparation is complete, you’ll receive the anesthetic through the IV and will fall asleep.

During surgery, a Foley catheter may be placed through your urethra and into your bladder. This is a hollow tube used to drain urine. You’ll also have a breathing tube placed in your windpipe. A breathing machine (ventilator) will control your breathing. Also, a nasogastric tube may be placed in your nose. This is a suction tube that extends into the esophagus and stomach to drain stomach contents.
What is removed during surgery and where your incisions are depend on the type of surgery you have. This is based on where the tumor is.

After your surgery is done, medical staff will move you to the recovery room. There, they will watch you for another hour or two. When you wake up, don’t be alarmed by the number of tubes and wires attached to you. These are normal monitors for after surgery. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stabilized, the staff will transfer you to the regular hospital floor.

What to expect after surgery

When you first wake up, you might have some pain. Your doctor or nurse will give you pain relievers as needed. These can help you feel more comfortable. The pain medicines will also help you get up and walk the day after your surgery. This is important for your recovery.

It will take time to get back to eating normally and having regular bowel movements. You will still have the Foley catheter in your bladder to drain urine. It allows your healthcare providers to measure your urine output and keep track of your fluid status. It’s normally removed before you go home.

How long you stay in the hospital will depend on the type of surgery you have. People who have a minimally invasive (laparoscopic) esophagectomy can often go home sooner. This is because they have smaller incisions that can normally heal faster.

You can slowly return to most normal activities once you leave the hospital. But you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your healthcare team.
After surgery, you may feel weak or tired for a while. The amount of time it takes to heal from an operation is different for each person. You may not feel like yourself for several months. Your healthcare providers will give you instructions about whether and when you can get your incisions wet. You likely won’t be able to drive for a while, as directed by your healthcare providers.

Talk to your healthcare team

If you have any questions about your surgery, talk to your healthcare team. They can help you know what to expect before, during, and after your surgery.

Pancreatic Cancer: Surgery

Surgery can sometimes be used to treat pancreatic cancer. Different kinds of surgery may be done. The type you have depends on where the cancer is, how much it has spread, the goal of surgery, and other factors.

When might surgery be used for pancreatic cancer?

Surgery is sometimes an option to try to remove all of the cancer if it’s still at an early stage. Unfortunately, pancreatic cancer has often spread too far by the time it’s found to remove it all. For more advanced cancers, surgery can also sometimes be used to help prevent or relieve symptoms.

If your healthcare provider recommends surgery, be sure you understand the goal of the operation. Is it to try to cure your cancer or is there a different goal? Surgery for pancreatic cancer is complex. It can cause major side effects, so it’s important that you understand it and are healthy enough for it. You should also have it done at a center that has experience treating this cancer.

Types of surgery for pancreatic cancer

Surgery to determine the extent of the cancer

Staging laparoscopy

Surgery to remove pancreatic cancer is a major operation. It’s very important to know just how far the cancer has spread before attempting this type of surgery. Sometimes it can be hard to tell how far the cancer has spread based on imaging tests alone. So, your healthcare provider may recommend laparoscopic surgery first. This can give your healthcare team a better idea of exactly how far the cancer has spread. This can help them determine if surgery to remove the cancer might be an option.
For this surgery, your surgeon makes several small incisions in your abdomen. Then he or she inserts long, thin tools, one of which has a small video camera on the end, into the incision. This lets the surgeon look at your pancreas and nearby organs. He or she can also take biopsy samples to check how far the cancer has spread.

Surgery to try to remove all of the cancer
Whipple procedure (pancreaticoduodenectomy)

This is the most common surgery for removing tumors from the pancreas. It’s used for cancers in the head of the pancreas. In this complex operation, your surgeon removes:

• Head of your pancreas, and sometimes the body of the pancreas as well

• Duodenum (first part of the small intestine)

• Part of your stomach, in some cases

• Gallbladder and part of the common bile duct

• Nearby lymph nodes

After this surgery, bile from your liver, food from your stomach, and digestive juices from the remaining part of your pancreas all enter your small intestine. You can still digest foods, but some people might need to take pancreatic enzymes to help with this.

Total pancreatectomy

You may have this surgery if the cancer has spread through your pancreas, but not beyond it. This is done less often than the Whipple procedure. In this operation, your surgeon removes the following:

• Entire pancreas

• Duodenum

• Part of your stomach

• Spleen

• Gallbladder and part of the common bile duct

Once your surgeon removes your pancreas, you won’t be able to make pancreatic juices or insulin. You’ll have diabetes, so you’ll need to test your blood sugar levels, give yourself insulin shots, and take other steps to keep your blood sugar in check. You’ll also need to take pancreatic enzyme pills with food to aid in digestion.

Distal pancreatectomy

This surgery might be an option if your cancer is confined to the tail of your pancreas. For this operation, your surgeon removes only the tail of your pancreas. He or she may also take out part of its body, the middle section. The surgeon also usually removes your spleen. This operation is not done much because tumors in the tail of the pancreas have usually spread by the time they’re found.

Palliative procedures

For more advanced cancers, sometimes other procedures can help with certain symptoms. But these surgeries cannot cure the cancer. These procedures may help restore your bile flow, allow food to leave your stomach into your small intestine, or ease pain.

For instance, surgery may relieve a blocked bile duct by bypassing it. Surgery may also relieve a blockage at the outlet of your stomach to the first part of the small intestine by bypassing it. This is called gastric bypass surgery. These are some of the types of palliative surgery:

• Surgery to redirect the flow of bile directly into your small intestine

• Surgery to allow your stomach to empty into another part of your small intestine

• Injections to block or numb nerves near your pancreas to prevent or relieve pain

• Placing a small tube (stent) inside the bile duct or duodenum to help keep it open
Possible risks, complications, and side effects of surgery

All surgery has risks. Some of the risks of any major surgery include:

• Reactions to anesthesia

• Excess bleeding

• Blood clots in your legs or lungs

• Damage to nearby organs

Risks from surgery for pancreatic cancer

Along with the risks above, pancreatic cancer surgery can sometimes cause other problems.
Infection

Pancreatic cancer surgery increases your risk for infection. Healthcare providers can treat some skin infections by allowing them to drain and by using clean dressings. More serious infections can occur inside your abdomen. These may require additional surgery. Antibiotics are often very helpful in treating infections.

Anastomotic leak

After your surgeon removes parts of your stomach, intestines, and/or bile ducts, he or she attaches them back together. Leaks can sometimes occur at these spots. If the leak is small, treatment may involve observation and diet. This lets it heal itself over time. If the leak is large, it can be life-threatening. You may need surgery to fix it.

Changes in bowel function and what you can eat

Some people might need to take enzyme supplements or change their diets. They might also have different bowel patterns after surgery.

Diabetes

If a large part or your entire pancreas is removed, you might have trouble controlling your blood sugar levels. You might need to take insulin.
Getting ready for your surgery
Before you go for surgery, you’ll meet with your surgeon to talk about it. At this time, ask any questions and share concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you have discussed all the details with your surgeon, you’ll sign a consent form that says that he or she can do the surgery.
A few days before your surgery, your healthcare provider might give you laxatives and enemas to help clean out your colon. He or she will tell you when and how to use these. You may also be told to follow a special diet.

On the day of your surgery, you should arrive at the hospital admission area a couple of hours before the time your surgery is set to start. There, you’ll complete the needed paperwork and go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time, your healthcare team will ask you about your health history. They’ll also ask about medicine allergies and talk about the procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.

While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist will do an evaluation. He or she will also explain the anesthesia you’ll have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won’t feel any pain. Be sure to answer all the questions thoroughly and honestly. This will help prevent complications. Also, ask any questions you have about your anesthesia. You will sign a form that states that you understand the risks involved.

Your surgeon will also see you in the preoperative area. You can ask any last-minute questions you have. This will help put your mind at ease.

What to expect during surgery

When it’s time for your surgery, you’ll be taken into the operating room. There will be many people there. These include the anesthesiologist, surgeon, and nurses. Everyone will be wearing a surgical gown and a face mask. Once in the room, someone will move you onto the operating table. There your anesthesiologist or nurse will place an intravenous line (IV) into your arm. This requires just a small skin prick. Someone will place special stockings on your legs to help prevent blood clots. EKG wires with small, sticky pads on the end will be attached to your chest. This is done to monitor your heart. You’ll also have a blood pressure cuff wrapped around your arm. When all the preparation is complete, you’ll receive the anesthetic through the IV and will fall asleep.

During surgery, a Foley catheter may be placed through your urethra and into your bladder. This is a hollow tube used to drain urine. You’ll also have a breathing tube placed in your windpipe. A breathing machine (ventilator) will control your breathing. Also, a nasogastric tube may be placed in your nose. This is a suction tube that extends into the esophagus and stomach to drain stomach contents.
What is removed during surgery and where your incisions are depend on the type of surgery you have. This is based on where the tumor is.

After your surgery is done, medical staff will move you to the recovery room. There, they will watch you for another hour or two. When you wake up, don’t be alarmed by the number of tubes and wires attached to you. These are normal monitors for after surgery. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stabilized, the staff will transfer you to the regular hospital floor.

What to expect after surgery

Your hospital stay will depend on the type of surgery you had. Recovery after you leave the hospital may last for one month or more.

For the first few days, you’re likely to have pain from the incisions. You can control your pain with medicine. Your doctor will prescribe this to you. You may have an epidural catheter put into your lower back so that it’s easier to give you pain medicine. You may have a patient-controlled analgesia pump (PCA). This is an IV form of pain medicine that you control by pressing a button. Before you leave the hospital, your healthcare provider will give you an oral pain medicine instead. Talk with your healthcare team about your options for pain relief. Some people are hesitant to take pain medicine, but doing so can actually help your healing. If your pain is not controlled well, for instance, you may not want to cough or walk. You need to do this while you recover from surgery.

Your healthcare provider may have placed a small drain or drains in your lower stomach during surgery. You may go home with one or more drains still in place.

You may feel tired or weak for a while. The amount of time it takes to heal from an operation is different for each person.

You may have constipation from using pain medicine, not moving around, or not eating or drinking very much. Talk with your healthcare provider about how to keep your bowels moving.
If your surgeon removed your entire pancreas, you no longer make enough insulin. This leads to diabetes. You’ll need to learn how to test your blood sugar and to give yourself insulin shots. The diabetes educator at the hospital will help you to manage your diabetes. He or she will teach you how to keep your blood sugar levels within a normal range.

If your surgeon removed your pancreas, or it can no longer make enzymes, you may need to take digestive enzyme tablets to help you digest food.

You’ll also need follow-up care after surgery. Make an appointment with your surgeon and get any other information for home care and follow-up when you leave the hospital.
Talk to your healthcare team
If you have any questions about your surgery, talk to your healthcare team. They can help you know what to expect before, during, and after your surgery