Pancreatic Cancer Surgery Dhaka

• Head of pancreas / periampullary — Whipple procedure (pancreaticoduodenectomy)
• Body and tail — distal pancreatectomy with splenectomy
• Diffuse / multifocal disease — total pancreatectomy (rare; results in lifelong diabetes and pancreatic-enzyme replacement)
• Locally advanced — neoadjuvant chemotherapy followed by re-staging and possible resection

Workup includes triple-phase pancreatic-protocol CT, MRI/MRCP, CA 19-9, endoscopic ultrasound (EUS) with FNA biopsy, and (where indicated) staging laparoscopy to exclude peritoneal metastases. Resectability is classified as resectable, borderline resectable, locally advanced, or metastatic — based on tumour contact with the superior mesenteric artery, coeliac axis, portal vein, and SMV. Borderline cases benefit from neoadjuvant FOLFIRINOX before surgery.

Pancreatic surgery is technically demanding because the pancreas sits behind the stomach and is intimately related to the major mesenteric vessels. Dr. Arefin uses careful arterial-first dissection, en-bloc removal with adequate margins (R0), and standard regional lymphadenectomy. Where the tumour abuts the portal vein/SMV, segmental venous resection and reconstruction is performed. Operative time is typically 6–8 hours.

5-year survival after R0 resection is 20–25% for ductal adenocarcinoma and 50–70% for ampullary and well-differentiated neuroendocrine tumours. Adjuvant FOLFIRINOX or gemcitabine-capecitabine is the global standard after recovery (started within 8–12 weeks of surgery) and is coordinated with medical oncology. Book a consultation for a personalised resectability assessment.