We understand that undergoing an operation can be a scary experience for you and your family. The Pancreas Center surgery team and the NewYork-Presbyterian Hospital staff will do everything they can to prepare you for your surgery. By the day of your scheduled operation, you should arrive at the hospital as relaxed as possible and feel confident that our team will take excellent care of you. Here is a summary of how your day will go:
Arrive and Register at Milstein Hospital Building
- The Surgical Nursing Unit will call you between 12:00 and 3:30pm the day before your operation to confirm your arrival time. If they have not called you by 3:30pm, please call (212) 305-0973.
- Plan to arrive at the Milstein Hospital Building, 177 Fort Washington Avenue, 1 1/2 hours before your scheduled surgery time. Security in the lobby will direct you to the Admitting Department. Be sure to bring your insurance card with you. Do not bring large sums of money, jewelry or other valuables with you to the hospital.
- After checking in with the Admitting Department, you will be brought to a preoperative area and given a hospital gown and an ID bracelet. When you change into your hospital gown, you should give all your personal belongings to the nurse to place in a secure locker or to the friend or relative who has accompanied you to the operation. Your family and/or friends will be allowed to stay with you until you are taken to the anesthesia consultation, after which they will be asked to wait in the designated waiting area.
- A nurse will check your vital signs (temperature, pulse, blood pressure) and go over your medical history.
- Members of your surgical team will come to speak with you while you are in the preoperative area to confirm the procedure you are scheduled for and to answer any last minute questions you may have.
Before entering the operating room, you will meet the anesthesiologist in charge of your case. Your anesthesiologist will review your medical history and explain how anesthesia will be administered during the procedure. All patients undergoing pancreatic operations receive general anesthesia. This means you will be asleep and will be unaware of your surroundings once the anesthesia is administered.
Once you have met with your anesthesiologist and your surgical team in the preoperative area, you will be taken to the operating room. The duration of your operation depends on the type of surgery you are having, as well as the location and pathology of your tumor. For more information on the type of operation you are having, please refer to the descriptions of each operation in the Pancreas Education section of this website by clicking here.
Directly after your operation, you will be brought to the recovery room. A member of your surgical team will meet you there to discuss the outcome of your operation. Nurses on the recovery team will also monitor you closely, and ensure you are comfortable. Your family and friends will be allowed to visit you. You can expect to stay in recovery for several hours after your surgery, sometimes overnight, before being moved to the surgical unit where you will continue to be monitored closely. Some patients may also be transferred to the intensive care unit (ICU).
Preparing for an operation can be a confusing process. We hope the information provided here will help you get ready for your procedure. By informing yourself, you can help ensure that your preparation for surgery can proceed as smoothly as possible. If you have questions before your surgery, please contact a member of the Pancreas Center staff.
Do not eat or drink anything after midnight on the day of your scheduled operation. This precaution is to prepare your body for the anesthesia. You may take your usual asthma, heart, blood pressure or seizure medication with a small sip of water that morning, unless otherwise advised by your surgery team. Make sure to read the Medication Adjustments section below for further information about medications.
The Surgical Nursing Unit will call you between 12:00 and 3:30pm the day before your operation to confirm your arrival time. If they have not called you by 3:30pm, please call (212) 305-0973.
During the weeks leading up to your surgery, several things will need your attention:
Federal and state guidelines, as well as sound medical practice, dictate that you have tests of your vital processes prior to surgery. Though additional tests may be required depending upon your particular type of surgery and condition, the following are standard requirement for all surgical patients
- Complete Blood Count (CBC)
- Basic Metabolic Panel
- EKG (for patients 40 years and older)
- Chest X-Ray (for patients 60 and older)
Your blood tests and EKG must be performed within 14 days of the scheduled surgery date. Chest X-rays can be completed as early as 6 months ahead of time. Ideally, all tests should be completed about one week prior to your surgery date. We will help you schedule any tests you need on the same day as your preoperative evaluation with a Pancreas Center nurse practitioner to make things as convenient as possible for you.
You will be scheduled for a preoperative evaluation with a Pancreas Center nurse practitioner about one week prior to surgery. The purpose of the pre-op visit is to ensure that you understand all pre-operative instructions, review what to expect in the weeks following surgery, and to give you the opportunity to ask any remaining questions you may have about your upcoming operation.
During your preoperative evaluation, your Pancreas Center nurse practitioner (NP) will go over portions of your medical history that need to be addressed as well as identify or review any special needs you may have in the pre- or post-operative period. Your NP will also carefully review the medications you are currently taking as you may have to temporarily stop or substitute some of them. It may help to bring a copy of the medication list you created for your surgical consultation with you to help you through the conversation.
Standard medication adjustments (subject to confirmation with your NP) include:
- Stop taking aspirin, ibuprofen and vitamin E for one week prior to surgery, unless otherwise directed by your doctor
- If you are currently taking Coumadin, steroids, and/or insulin, you may need to adjust your dose or substitute another medication before surgery. Make sure to discuss this with your surgeon or NP before your operation.
During your preoperative evaluation, a member of the Pancreas Center may also talk to you about enrolling in one or more clinical trials currently open at the Pancreas Center. To learn more about our current clinical trials, click here.
Please make sure that we have your latest insurance information including the name of your carrier, the name of the insured on the policy, the policy number, and the phone number we need to call to precertify tests and procedures. All of this information can be found on your insurance card. Be sure to call your insurance company to verify your benefits. It is important to keep in mind that precertification is not a guarantee of payment by your insurance carrier.
If you are working, you should expect to be out of work for one to two months following your surgery. It is important for you to alert your employer of your leave and make any necessary arrangements pertaining to your job. Any disability forms should be submitted directly to the Pancreas Center office after your operation. When you submit these forms, please make sure to clearly indicate where we should send the forms and by what date. Keep in mind that it will take roughly two weeks for our office to process and send your disability forms.
Depending on the type of operation you are having, you can expect to stay 3-10 days in the hospital after your surgery. Standard hospital accommodations are semi-private rooms, where patients share a room with one person of the same gender. In semi-private rooms, a patient's family and friends are only allowed to stay with the patient during regular visiting hours.
Deluxe hospital accommodations are available for those patients who prefer more privacy and comfort during their stay.
- Private Room on Surgical Floor–These private accommodations are on the same floors as the regular rooms
- The McKeen Pavilion–The hotel-like facility offers suites with tasteful and elegant decor and sweeping Hudson River views that include a visitor's sitting room with sleeper sofa and bathroom
In these rooms, family and friends can visit with patients for longer, and sometimes even spend the night with patients as they recover. It is important to note, though, that these accommodations are generally more expensive; these additional costs are not covered by most insurance carriers. If you would like to arrange for deluxe accommodations, please call the office of your Pancreas Center surgeon.
As with all major operations, recovering from pancreatic surgery takes time. Full recovery requires an average of two months. Your recovery can be divided into different stages, each of which carry a different set of expectations. However, it is important to remember that every patient's recovery is different, even patients undergoing the exact same procedure.
Patients spend an average of 3-10 days in the hospital after pancreas surgery. While you are in the hospital, many members of your health care team will be checking in on you daily. Your in-house team consists of residents, medical students, nurses, and your surgeon. Your team will closely monitor your progress throughout your stay. You will be seen by residents and nurses several times each day and by your surgeon and/or one of our Pancreas Center surgeons at least once each day.
It is normal to experience pain after pancreas surgery. While in the hospital, you will be able to manage your pain with intravenous pain medication. Once you are at home, you will manage your pain with oral medications prescribed by your health care team.
After your operation, you will have staples and special dressings where incisions were made during your procedure. You may also have some surgical drainage tubes left in your abdomen. Your team will check your dressings regularly to ensure they are healing well and monitor any tubes to ensure proper drainage. It is normal to be discharged home with the surgical drainage tubes still in place, so do not be worried about your recovery if this happens to you. You will be given specific instructions on how to care for both the drainage tubes and your surgical dressing before you are discharged from the hospital; both will be removed during one of your postoperative visits to the Pancreas Center.
Due to a condition known as "gastric ileus," or temporary paralysis of the stomach, you will not be able to eat for many days after your surgery. While you are in the hospital, your health care team will ensure you receive proper hydration intravenously. There is no way to predict how quickly your stomach will regain its full function after an operation, and patients must undergo a trial-and-error process as they attempt to resume normal eating. While this process can be frustrating, it is also perfectly normal. You will not be discharged from the hospital until you can tolerate food and liquid, however it still may take several weeks before your digestive system returns to "normal."
Many people are eager to be discharged from the hospital after surgery, and your health care team will do everything they can to return you to your home life. Before we can discharge you, though, there are certain requirements you must meet. You should:
- Have no unresolved medical or surgical issues
- Have a stable temperature and not show signs of fever
- Be able to walk unassisted
- Be able to tolerate food and liquid
- Be able to perform basic activities of daily living like brushing your teeth and washing your hair
Once you meet these requirements, you will be eligible for discharge. In some instances, especially in cases of elderly patients, we may recommend a stay in a skilled nursing or rehabilitation facility before going home. Recovering from a major operation like pancreas surgery can be difficult and it helps to have trained professionals to assist in your recovery. This option may be addressed during your preoperative evaluation, but is often better defined directly after surgery.
While you will be able to leave the hospital after a few days or weeks, remember that a full recovery from pancreas surgery can take two months or longer. During the first two months, we will ask you to come into the Pancreas Center clinical office every two weeks for postoperative evaluations. At your first postoperative visit, you will meet with your surgeon and/or a nurse practitioner who will review your pathology and surgical reports. Your incisions will be examined and staples and tubes will be removed. At this, and at subsequent postoperative evaluations, your team will also talk to you about your diet, bowel functions, and pain control to ensure you are recovering well. It may help to keep a journal of what you are eating and drinking, how much of it you are consuming, and at what times you are able to eat. This will not only help your conversation with your health care team during your postoperative visits, but will help you understand what kinds of foods you are tolerating. If you are having issues with your diet, your doctor/nurse may refer you to our clinical nutritionist to help you with your individual needs.
After the first two months of very regular postoperative evaluations with the Pancreas Center surgery team, frequency of your follow up evaluations will be reduced to every 3-6 months. Depending on the type of resection and the resulting pathology, we may also ask you to undergo regular imaging studies such as MRI or CT to check for recurrence of cancer. We will also perform regular blood tests to ensure important indicators like tumor markers and liver function tests remain within normal ranges.
Most patients who undergo surgery for pancreatic cancer will also require a course of chemotherapy after their operation, known as adjuvant chemotherapy. Your surgeon will refer you to a Pancreas Center oncologist or coordinate with a specialist closer to home. Since chemotherapy requires regular treatment over a period of time, it is important that you receive your therapy at a location convenient for you. Adjuvant treatment does not normally start until six to eight weeks after surgery.
Post-Operative Dietary Guidelines
After pancreatic surgery, it is normal to have difficulty eating or to experience nausea, vomiting or heartburn. These symptoms are caused by a condition known as "gastric ileus," or temporary paralysis of the stomach. It may take your digestive system anywhere from a few weeks to a few months to return to normal. There is no way to predict how quickly your stomach will regain full function, and patients must undergo a trial-and-error process as they attempt to resume normal eating. In some cases, patients find they must make permanent changes to their diet in order to alleviate diarrhea, gas, and stomach pain. In situations where gastric ileus persists, a supplemental feeding tube and/or a special IV called a PICC line can help to ensure the patient receives proper nutrients.
In general, when recovering from a pancreatic operation, the goal should be to eat small, frequent meals/snacks every three hours. Eat a protein containing food first each meal to minimize the amount of muscle mass you may lose. It is important to remember to drink fluids between meals to stay hydrated. Our clinical nutritionist has created a handout to help you anticipate what to expect after your surgery including food recommendations and some helpful tips for minimizing gastrointestinal upset.
For more information, call us at (212) 305-9467 or reach us through our online form.