Pancreatic Cancer Surgery in Uberlândia-MG

The most characteristic signs include jaundice (yellowing of the skin and eyes) accompanied by dark urine and pale stools, when the tumor is located in the head of the pancreas and obstructs the bile duct. Upper abdominal pain radiating to the back, unintentional weight loss, loss of appetite, nausea, and new-onset diabetes without associated risk factors may also occur. These symptoms warrant medical evaluation and imaging investigation, although they may also be related to other conditions.

Initial investigation generally includes abdominal computed tomography with a pancreatic protocol and magnetic resonance imaging with cholangiopancreatography, which assess the lesion and its relationship to vascular structures. The CA 19-9 tumor marker supports diagnosis and follow-up, although it is not diagnostic on its own. Histological confirmation can be obtained through endoscopic ultrasound with fine-needle biopsy. The combination of these tests defines staging and the possibility of surgical resection.

Pancreaticoduodenectomy is a highly complex procedure, with an average duration of 6 to 10 hours, which may vary depending on the patient's anatomy, the extent of resection, and the need for associated vascular reconstruction. This extended operative time reflects the procedure's multiple stages — resection and biliary, pancreatic, and digestive reconstruction — and the estimated duration for each case should be discussed individually with the surgical team.

The procedure is performed under general anesthesia, frequently combined with epidural analgesia techniques or other regional blocks to optimize postoperative pain control and reduce the need for opioids. The choice of anesthetic technique is determined by the anesthesiology team based on the patient's clinical condition and is discussed in advance during the preoperative evaluation.

Hospitalization after pancreaticoduodenectomy or distal pancreatectomy typically ranges from 7 to 14 days, including a period in the intensive care unit during the first hours or days, according to institutional protocol. Hospital discharge depends on recovery of bowel function, pain control, absence of signs of pancreatic fistula or other complications, and the ability to tolerate an oral diet. Actual duration varies from case to case.

Because this is extensive abdominal surgery, some degree of postoperative pain is expected, especially during the first days. Control is achieved through multimodal analgesia, combining epidural analgesia or regional blocks, intravenous analgesics, and, when necessary, opioids at adjusted doses. Pain intensity and duration vary among patients, and management is individualized by the acute pain team throughout hospitalization.

Yes. Abdominal drains are commonly placed near the pancreatic and biliary anastomoses to monitor secretions and allow early identification of a potential pancreatic fistula — one of the most significant complications of this surgery. A nasogastric tube may also be required during the first hours, and occasionally a urinary catheter. Each device is removed gradually, according to clinical progress and observed output.

With an open approach, the incision is usually midline or subcostal in the upper abdomen, and its length may vary depending on the technique used. When a laparoscopic or robotic approach is indicated, the scars are smaller, distributed across several small incisions. The choice of surgical approach depends on anatomical and oncologic factors and the surgical team's individual assessment, and should be discussed on a case-by-case basis before the operation.

Time away from work typically ranges from 4 to 8 weeks and may be longer depending on postoperative progress, the need for additional chemotherapy treatment, and the nature of the patient's occupation. More strenuous physical activities generally require specific medical clearance. Each patient's return to activities should be evaluated individually by the follow-up care team.

The most significant complications include pancreatic fistula, delayed gastric emptying, bleeding, surgical site infection, and intra-abdominal fluid collections, in addition to the general risks associated with major surgery. Surgery may not be indicated in cases of metastatic disease, extensive vascular invasion that precludes resection with clear margins, or when the patient's clinical condition does not allow a major procedure to be performed safely. Each case is evaluated individually.

In most cases, surgery is combined with neoadjuvant (before) or adjuvant (after) chemotherapy, depending on staging and tumor response; radiation therapy may be considered in selected situations. Treatment involves a multidisciplinary team — surgical oncologist, clinical oncologist, radiation oncologist when indicated, nutritionist, endocrinologist, and specialized nursing staff — for comprehensive care before, during, and after surgery.