Overview
A high-acuity operation deserves a high-acuity team.
Pancreatic surgery is one of the most demanding areas of general and oncologic surgery. The pancreas sits deep in the upper abdomen, behind the stomach and on top of the major blood vessels of the abdomen. Cancer arising from any part of the pancreas requires an operation tailored to its location — a Whipple for the head, a distal pancreatectomy with splenectomy for the body or tail, and a total pancreatectomy for diffuse disease. For a small subset of patients, minimally invasive (laparoscopic or robotic) approaches are appropriate.
Outcomes in pancreatic cancer are most strongly influenced by three things: the biology of the disease, the timing of surgery relative to systemic therapy, and the experience of the surgical team. Our role is to be the experienced surgical part of that equation — and to coordinate aggressively with medical oncology, gastroenterology, interventional radiology, and pathology so that every decision is integrated rather than isolated.
Who is a candidate?
Candidacy depends on three things: whether the tumor is resectable (or borderline-resectable) on imaging, whether the patient is medically fit for major surgery, and whether the cancer biology suggests surgery is the right next step. Many patients receive chemotherapy before surgery to shrink the tumor, treat possible microscopic spread, and identify patients whose disease progresses despite therapy. We work closely with medical oncology on this sequencing — surgery is one well-timed step, not a default first move.
How we perform it
The operation depends on tumor location. Whipple procedure: head of the pancreas — see our dedicated Whipple page. Distal pancreatectomy (often with splenectomy): body or tail tumors — typically a 3–4 hour operation with a 5–7 day hospital stay. Total pancreatectomy: diffuse disease — uncommon but sometimes necessary. We perform open surgery for most cases and minimally invasive approaches when the tumor location and biology allow. Throughout, the priorities are: complete tumor removal, clean (R0) margins, and careful, durable reconstruction.
Recovery
Recovery is gradual and varies by operation. Whipple patients stay 7–14 days; distal pancreatectomy patients usually stay 5–7 days. Pain control is multimodal and aggressive in the first week. Drains stay in for 1–2 weeks while we watch for pancreatic leak — the most common complication of pancreatic surgery. At home, weight and energy come back over 4–8 weeks; some patients require pancreatic enzyme replacement at meals and a small percentage develop new diabetes. We see patients back at 2 weeks, 6 weeks, and then on a coordinated schedule with medical oncology and imaging.
Why Florida Surgical
Pancreatic cancer outcomes are tied to surgeon and team volume. Dr. Shaw is fellowship-trained in surgical oncology with a primary focus on cancers of the pancreas, liver, and biliary system. We coordinate every pancreatic cancer case across surgery, medical oncology, gastroenterology, interventional radiology, and nutrition — and the surgeon who plans your operation is the surgeon who performs it and follows you afterward. We are happy to provide a second opinion on outside cases.
Frequently asked questions
Should I have chemotherapy before or after surgery?
For most pancreatic adenocarcinomas, current evidence favors neoadjuvant (before-surgery) chemotherapy — typically a 2–4 month course followed by restaging. This treats possible microscopic spread, lets us see how the tumor's biology responds, and may shrink the tumor enough to make surgery more straightforward. The exact sequencing is decided jointly with medical oncology.
Will I be able to digest food normally after surgery?
Most patients do well over time. Many require pancreatic enzyme supplements with meals, especially after a Whipple or total pancreatectomy. We work closely with nutrition to manage weight, appetite, and any new diabetes.
How is this different from a Whipple?
A Whipple is the operation for tumors in the head of the pancreas. For tumors in the body or tail, the operation is a distal pancreatectomy (often with removal of the spleen). For diffuse disease, a total pancreatectomy. We use the term 'pancreatic cancer surgery' to cover all of these.
What if my cancer is borderline-resectable or locally advanced?
These cases need extra planning. We meet with medical oncology and review high-quality cross-sectional imaging together. Many borderline-resectable tumors can be downstaged with chemotherapy and become operable; some locally advanced tumors are best treated with chemotherapy and radiation, and surgery is offered only if the disease responds favorably.
Should I get a second opinion?
Yes. We welcome second opinions for any pancreatic cancer case. The decisions made early — when and whether to operate, which operation, and when to give chemotherapy — have lasting consequences, and patients should feel confident in the plan.