Recovering After Pancreatic Cancer Surgery: 5 Top Tips

A Whipple procedure for early-stage pancreatic cancer represents the best chance of a cure for this aggressive type of cancer, experts say. But recovering from the complex procedure — which typically involves removing the head of the pancreas, parts of the small intestine and bile duct, the gallbladder, and possibly part of the stomach — can be extremely challenging, notes the Mayo Clinic.

Fewer than 20 percent of pancreatic cancer patients are considered eligible for the Whipple, which is usually available only to those with early-stage disease that hasn’t spread to other organs or extensively to nearby blood vessels. Some patients proceed with the surgery after a course of chemotherapy or radiation that helps shrink tumors sufficiently.

“It’s a major abdominal operation that requires rerouting several components of the digestive tract,” explains Kevin Roggin, MD, a professor of surgery and cancer research at University of Chicago Medicine. “So it takes the body a while to learn the new set of internal plumbing.”

Named for the American surgeon Allen O. Whipple, MD, who’s credited with popularizing the complex procedure in the 1930s, the Whipple procedure comes with a relatively high complication rate. But fewer than 3 percent of patients die during the operation, according to research.

After the lengthy surgery, patients usually spend about a week in the hospital, during which doctors aggressively manage pain and gradually reintroduce the digestive system to soft foods. Much of the recovery process centers on figuring out what foods “agree” with an individual patient, says Victoria Manax Rutson, MD, the chief medical officer of the Pancreatic Cancer Action Network (PanCAN).

“It’s very normal to experience nausea, vomiting, or heartburn,” Dr. Rutson says. “A lot of it is due to a temporary paralysis of the stomach. In some cases, patients have to make permanent changes to their diet because of diarrhea or stomach pain, but sometimes they find they enjoy different types of food more than they did before the Whipple.”

The Road to Recovery: 5 Top Tips

What can patients and caregivers do to smooth the recovery process? Rutson and Dr. Roggin offer this advice:

1. Collaborate on pain relief. Work closely with healthcare providers to manage postoperative pain, which may involve gradually tapering off stronger painkillers to over-the-counter versions. Pain can also stem from heartburn or bloating, not just incisions, so have discussions with your physician to describe the type and source of your pain.
2. Plan lighter meals. Eat small amounts many times a day rather than three larger meals, Roggin says. “Nutritionally, we have to be patient.”
3. Remember that blander is better. Stay away from spicy, fried, or heavy food until you’re well past the immediate postsurgical period. “Try to avoid foods that are difficult to digest,” Roggin says. “I typically put people on a mild diet, supplemented with protein shakes to help build up depleted protein stores.”
4. Monitor blood sugar. Many pancreatic cancer patients experience diabetes before diagnosis, but a Whipple procedure can worsen the condition because surgeons remove part of the pancreas, the organ responsible for insulin production. And some patients develop diabetes for the first time after a Whipple. “Patients should follow up with their primary care providers to make sure they haven’t become diabetic, and monitor blood sugar levels after surgery,” Roggin says.
5. Watch for cramps, gas, and bloating. These are possible signs of pancreatic enzyme insufficiency, which affects about half of all Whipple patients. People with this condition typically need to take oral pancreatic enzyme supplements to promote digestion. Most pancreatic cancer patients also take prescription antacids, plus a multivitamin with iron to replace lost nutrients.