The surgeon’s experience plays a key role in assessing whether a pancreatic tumor is operable or not. What is considered “unresectable” in a hospital may well be operable at a highly specialized center with the appropriate expertise. This is because the assessment of operability does not depend solely on the stage of the tumor, but also significantly on the skills, routine, and technical spectrum of the surgical team.

In the case of Prof. Dr. Dr. Markus W. Büchler and the Botton-Champalimaud Pancreatic Cancer Center, this means: Thanks to his decades of experience in pancreatic surgery, thousands of procedures performed, and his leading role in the further development of surgical techniques, Büchler can operate on even the most complex tumors—even if they involve vessels or are anatomically particularly challenging.

At the Botton-Champalimaud Pancreatic Cancer Center, such cases are discussed on an interdisciplinary basis and evaluated individually. Thanks to state-of-the-art technology, robot-assisted procedures, and extensive experience in treating high-risk patients, a much wider range of tumors can be treated surgically here than at conventional clinics. The surgical experience of Prof. Büchler and his team thus pushes the boundaries of what is possible – and offers patients with advanced pancreatic cancer a real chance at a potentially curative treatment.

Pancreatic Cancer (Pancreatic Carcinoma) remains one of the most aggressive types of cancer, with a comparatively poor prognosis. This is mainly because the tumor causes no symptoms or only vague ones for a long time, is often diagnosed at an advanced stage, and shows high resistance to many standard medications. Nevertheless, much progress has been made in recent years – and research is more active than ever before.

Current Status (2025)
Modern chemotherapy combinations such as FOLFIRINOX or gemcitabine combined with nab-paclitaxel have demonstrably extended survival for many patients – especially when treatment is carried out in specialized centers such as the Botton-Champalimaud Pancreatic Cancer Center under the direction of Prof. Dr. Dr. Markus Büchler. There, chemotherapy is combined with highly precise, often minimally invasive surgery, genetic diagnostics, and interdisciplinary follow-up care – a comprehensive approach that yields significantly better outcomes than standard treatment alone.

Future of Treatment – Current Research Directions
International cancer research is currently focusing on several promising approaches that could expand and significantly improve the existing treatment spectrum:

1. Immunotherapy
   While immunotherapies such as checkpoint inhibitors have achieved major successes in other cancers, pancreatic tumors have so far rarely responded – mainly due to their strongly “immune-resistant” tumor environment. Researchers are therefore testing combination therapies designed to specifically break through this barrier. These include specialized agents, mRNA-based cancer vaccines, and immune activators intended to “alert” the body’s immune system to the cancer cells.

2. Personalized Tumor Profiling and Targeted Therapies
   A key research focus is personalized cancer therapy. Through genetic and molecular analysis of an individual tumor (known as tumor profiling), medications can be specifically chosen to target the unique vulnerabilities of that tumor. Particular attention is being given to KRAS inhibitors – as around 90% of all pancreatic carcinomas carry a mutation in the KRAS gene.

While drugs targeting the KRAS G12C mutation are already clinically available (e.g., sotorasib), intensive research is underway into inhibitors against the far more common KRAS mutations G12D and G12V. So-called PARP inhibitors, effective in tumors with certain DNA repair defects (e.g., BRCA mutations), are also seeing increasing use.

3. Vaccine Strategies and mRNA Therapies
   Another breakthrough may come from mRNA-based cancer vaccines. Companies such as BioNTech are currently developing individualized mRNA vaccines for pancreatic cancer tailored to the tumor’s genetic characteristics. The aim is to activate the immune system after surgery so that it can detect and destroy any remaining cancer cells – thereby reducing the risk of recurrence.

Early clinical trials in patients with resected pancreatic cancer are already showing promising results. In the long term, mRNA vaccines could become an integral part of follow-up care. Centers like Prof. Büchler’s are actively involved in these studies and are already offering patients access to such innovative therapies within controlled research programs.

Conclusion and Outlook
Pancreatic cancer is still one of the greatest challenges in modern oncology. However, progress is clearly visible: modern chemotherapy, surgical excellence, tumor profiling, immunotherapy, mRNA-based treatments, and artificial intelligence in treatment planning are creating new therapy options that were once unthinkable.

Centers like the Botton-Champalimaud Pancreatic Cancer Center play a key role in this process. Here, treatment and surgery go hand in hand with research – with the goal of giving every patient access to the latest developments in cancer medicine. The future of pancreatic cancer treatment lies in individualized, multidisciplinary precision medicine – and it is beginning now.

The pancreas is a yellowish gland, about 15 cm long, 5 cm wide, and 2–3 cm thick. Located behind the stomach, the pancreas has two main functions: 1) digestion (exocrine function) and 2) regulation of blood sugar (endocrine function).

The pancreas produces digestive enzymes that are used to break down nutrients ingested with food, namely carbohydrates (amylase), fats (lipase), and proteins (protease). The pancreas also produces bicarbonate to neutralize the acidic gastric juice. This secretion is very active in digestion. To prevent the pancreas from digesting itself, the secretion contains precursors that only acquire their potency when they arrive in the small intestine.

Scattered throughout the pancreas are groups of cells called the islets of Langerhanns, which produce hormones, the body’s messengers. They do not enter the intestine via the secretion, but are transported via the blood to all organs (liver, brain, heart) that convert glucose as an essential source of energy for the cells. Other hormones are also produced in the pancreas, such as somatostatin and pancreatic polypeptide. All these hormones are involved in metabolism.

The pancreas produces important enzymes. It produces 1.5–3 L of enzyme-containing secretion daily. This digestive secretion is produced by specialized cells throughout the gland and is directed through a widely branched ductal system where it finally collects in a main duct called the “ductus pancreaticus”. Just before entering the duodenum, the pancreatic secretion is joined by bile from the liver. These secretions are passed into the duodenum, through the papilla Vateri. In the duodenum, the pancreatic enzymes are activated, allowing food coming from the stomach to be digested.

The pancreas produces more than 20 different digestive enzymes that break down food into its smallest building blocks. The three most important enzymes of the pancreas are:

• Amylase, which digests carbohydrates
• Trypsin, which digests proteins
• Lipase, which digests fats.

Food components need to be broken down into smaller pieces so the body can absorb them through the intestines. If the pancreatic enzymes are missing, the carbohydrates, proteins and fats are not broken down properly and the intestine is not able to transport the nutrients to the blood. The undigested food is then transported through the intestines, leading to diarrhea, flatulence, and abdominal cramps.

In addition to digestive enzymes, the pancreas produces an important hormone, insulin. Insulin is released directly from the pancreas into the blood. This hormone controls blood sugar levels. In a sense, it opens the doors of all the body’s cells to allow sugar in. Glucose is the most important sugar molecule and all cells depend on glucose. Insulin enables glucose to pass from the blood into the body’s cells. If there is too little or no insulin, glucose cannot pass from the blood into the body’s cells. This causes blood glucose to rise, which has life-threatening consequences for humans. Diabetics do not produce enough insulin so have sustained high blood sugar levels.

The pancreas produces another important hormone, glucagon. When low blood sugar threatens the function of cells, glucagon releases glucose from reserves in the body, especially in the liver, and blood sugar rises. If the pancreas is absent, this important hormone cannot be produced. This must be taken into account when treating pancreas-operated patients.

Pain or discomfort in the upper and middle of the abdomen is the most common complaint in pancreatic diseases. Typically, abdominal pain is belt-shaped or radiates to the back (the pancreas is located in the back of the abdomen, which explains the back pain). The pain may be quite sudden and severe (acute pancreatitis), recurrent (chronic pancreatitis), or slowly increasing (pancreatic tumor). Jaundice is also a prevalent manifestation of pancreatic diseases, especially pancreatic tumors, and is caused by occlusion of the bile duct by tumors in the pancreas head. Other symptoms of pancreatic disease include diarrhea, bloating, flatulence, or diabetes. Other signs and disorders are due to the reaction of the immune system to the cancerous tumor, known as a “paraneoplastic syndrome”. These signs include weight loss, skin lesions, and fatigue.

Pancreatic cancer is a very serious disease that must be treated very quickly. The earlier the disease is detected, the better your chances of survival. In addition to talking to your doctor and undergoing a physical examination, other methods must be used to diagnose pancreatic cancer, including laboratory tests, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography (PET). In some patients, an endoscopic examination of the duodenum with X-rays of the bile and pancreatic ducts is also required.

The international standard treatment for pancreatic cancer is a combination of surgery and chemotherapy, supplemented by radiation therapy in certain cases. A cure is generally only possible if the tumor can be completely removed.

If the tumor is operable, surgery should be performed as early as possible. Approximately eight weeks after the procedure, supplementary chemotherapy follows to combat any remaining cancer cells in the body. If the tumor is inoperable at the time of diagnosis—for example, because it involves important blood vessels or metastases are present—treatment usually begins with intensive chemotherapy. The aim is to shrink the tumor to such an extent that surgery becomes possible at a later date – usually after three to six months.

Even if metastases are initially detected in the liver, lungs, or other organs, if the patient responds well to chemotherapy – i.e., if the metastases shrink or disappear completely – the original tumor can then be surgically removed.

Prof. Dr. Dr. Markus Büchler and the team at the Botton-Champalimaud Pancreatic Cancer Center consistently implement this therapeutic approach. Through close coordination between oncological therapy and highly specialized surgery, even complex cases can be individually assessed and treated surgically – with the aim of opening up a chance of cure even in advanced cases.

Pancreatitis is the inflammation of the pancreas and can be acute or chronic.

Acute pancreatitis is an acute inflammation of the pancreas, often caused by gallstones blocking the pancreatic duct or by too much alcohol damaging the cells of the pancreas. Acute pancreatitis is dangerous and should be treated in hospital. Inflammation causes the pancreas to swell, bleed, and self-digest and may affect other organs. In 85% of cases, acute pancreatitis is mild whereas in 15% of cases it is life-threatening. Acute pancreatitis is usually treated medically or interventionally (such as endoscopic treatments) and surgery is only needed in case of complications, such as abscess formation or extensive tissue damage.

Chronic pancreatitis is an inflammation of the pancreas that usually progresses over years and causes severe pain. It is triggered by alcohol in 80% of cases. Repeated episodes of inflammation lead to an increasing loss of function and deficiency of digestive enzymes, vitamins, and insulin. The pancreas is severely altered over the years, hardening and even calcifying. Chronic pancreatitis can lead to cancer, so patients with chronic pancreatitis need regular check-ups by a specialist. One in two patients with chronic pancreatitis will require surgery during the course of their disease. This must be performed very carefully and in specialized hospitals. Surgery may be necessary for the following reasons:

1. If the pain cannot be controlled with conservative or interventional methods.
2. If chronic inflammation of the pancreas has blocked the duodenum, bile duct, main pancreatic duct, or vessels behind the pancreas.
3. If it is unclear whether a tumor has developed.

The best time for surgery must be discussed with an experienced pancreatic surgeon. Early removal of the inflamed area can help preserve important pancreatic functions such as digestion and blood sugar control.

There are various reasons why surgery on the pancreas may become necessary. These include, for example, chronic inflammation (pancreatitis), abnormal tissue changes with suspected cancer, as well as benign or malignant tumors in the pancreas or in adjacent areas such as the bile duct or duodenum.

The most common reason for pancreatic surgery is a tumor – either already malignant or at high risk of becoming malignant. In cases of acute pancreatitis, surgery is only performed if severe complications arise. In chronic pancreatitis, surgery is generally considered only after several years – usually three to five – if symptoms or functional impairments increase.

There are different surgical methods for operating on the pancreas. In many cases today, minimally invasive techniques are used – meaning surgery is performed through small incisions with the help of a camera (laparoscopically) or using a surgical robot. These techniques are considered particularly gentle. However, in some cases, a traditional open surgery via an abdominal incision is still necessary. The choice of method depends on the specific condition, the patient’s overall health, and the experience of the surgical team.

As with any major surgery, pancreatic procedures carry certain risks. These include infections, bleeding, fluid accumulation in the abdominal cavity, or – more rarely – fistulas, where pancreatic fluid or bile leaks into the abdomen. Pneumonia, heart problems, or blood clots may also occur. However, most of these complications can be treated effectively – with medication, drains, targeted interventions, or, in rare cases, a second surgery.

The experience of the medical team is crucial for treatment success. Studies show: the more frequently a hospital performs complex pancreatic surgeries, the lower the risk of complications. Prof. Dr. Dr. Markus Büchler, one of the world’s leading pancreatic surgeons, personally operates on even the most severe cases at the Botton-Champalimaud Pancreatic Cancer Center. Supported by a specialized team and the most advanced technology, he can treat patients whose cases are considered too complex at other hospitals. The combination of surgical precision, minimally invasive techniques, and decades of experience increases surgical safety and significantly improves the chances of recovery.

Yes, it is possible to live without a pancreas – but it requires careful medical supervision and lifelong support through medication and specialist care.

The pancreas performs two vital functions in the body: it produces digestive enzymes, which ensure that nutrients from food can be absorbed, and it produces the hormone insulin, which regulates blood sugar levels.

If the pancreas is completely removed – for example, during cancer surgery – the body can no longer carry out these functions on its own. The missing substances must therefore be replaced artificially:

• Digestive enzymes are taken in tablet form with every meal to ensure that fats, proteins, and carbohydrates are properly processed.

• Since the body can no longer produce its own insulin, a so-called “surgically induced diabetes” develops. This means blood sugar must be monitored regularly and insulin injected – similar to type 1 diabetes.

To ensure the best possible balance between diet, blood sugar control, and medication, close cooperation between different medical specialties is essential. Surgeons, endocrinologists (hormone specialists), gastroenterologists, and dietitians work together to create an individual follow-up plan.

At the Botton-Champalimaud Pancreatic Cancer Center, led by Prof. Dr. Dr. Markus Büchler, such procedures are performed particularly often. Thanks to the team’s extensive experience in pancreatic surgery and interdisciplinary care, patients receive not only highly precise operations but also comprehensive support afterward. The goal is to maintain a high quality of life despite the removal of the pancreas – with as few limitations in everyday life as possible.

Conclusion: Living without a pancreas is challenging, but with the right medical support, it is entirely feasible. The key is treatment in an experienced center where all relevant specialties work closely together.

If part or even the entire pancreas is surgically removed – for example, as part of cancer treatment – this can permanently impair the organ’s function. The severity of the consequences depends on how much tissue was removed and whether the remaining pancreas is still functional.

In general, two main problems can occur after pancreatic surgery:

• Digestion becomes less effective because not enough enzymes are produced to process food.

• Blood sugar levels rise because the pancreas produces less or no insulin.

Both functions – enzyme production and insulin secretion – can now be well replaced with medication. What matters is an individually tailored treatment plan and close medical supervision.

1. Replacement of Digestive Enzymes (Enzyme Substitution)
The pancreas produces enzymes that break down fats, proteins, and carbohydrates in the intestine. If these enzymes are lacking, digestive problems, bloating, diarrhea, and weight loss can occur. To prevent this, patients receive so-called pancreatic enzymes in tablet form, for example, the medication Kreon.

These enzyme preparations must be taken with every main meal and snack – not occasionally, but consistently. The exact dosage depends on the meal, individual tolerance, and the remaining function of the pancreas. Larger meals generally require higher doses than snacks.

Although this initially requires some adjustment, many patients – even after major surgery – report a good quality of life. An important factor is a balanced, fat-adjusted diet with several small meals per day (e.g., 5–6 instead of 2–3). This helps relieve the digestive tract and allows the enzymes to work more effectively.

2. Blood Sugar Control and Insulin Replacement
If a large proportion of the insulin-producing cells is removed during surgery, elevated blood sugar levels or diabetes can occur. This usually affects patients who have had more than 60–90% of their pancreas removed or whose gland was already damaged by chronic inflammation.

In milder cases, dietary adjustments or oral blood sugar–lowering medication may be sufficient. More often, however, regular insulin therapy is required, similar to type 1 diabetes. Especially during the first weeks after surgery, close monitoring by a general practitioner or diabetologist is essential to optimally adjust blood sugar control.

Treatment at the Botton-Champalimaud Pancreatic Cancer Center with Markus Büchler
At the Botton-Champalimaud Pancreatic Cancer Center in Lisbon, under the leadership of Prof. Dr. Dr. Markus Büchler, great emphasis is placed on comprehensive care. The experienced team of surgeons, endocrinologists, nutrition specialists, and nursing staff supports patients not only during surgery but also intensively in the recovery period afterward.

With decades of experience in pancreatic surgery and the most advanced medical techniques, the team can successfully treat even severe cases – with the aim not only of saving lives but also of maintaining long-term quality of life.

Pancreatic cancer is often diagnosed only at an advanced stage. By this time, the tumor has frequently grown into surrounding tissue or has formed metastases (secondary tumors) in other organs such as the liver or lungs. A complete, curative operation is usually no longer possible at this point.

Nevertheless, today – especially at highly specialized cancer centers such as the Botton-Champalimaud Pancreatic Cancer Center under the direction of Prof. Dr. Dr. Markus Büchler – there are various treatment approaches that can significantly extend survival and improve quality of life.

A central component is modern chemotherapy, which, with the help of new drug combinations, can slow tumor growth, relieve symptoms, and, in some cases, shrink the tumor enough to make surgery possible after all. This so-called secondary resection is assessed individually at Prof. Büchler’s center and carried out in suitable cases.

If a cure is no longer possible, palliative treatments are used. The goal is to relieve symptoms and prevent complications – without placing unnecessary strain on the body. These include:

• Chemotherapy to slow the progression of the disease

• Surgical removal of individual metastases, such as in the liver or lungs, where appropriate and feasible

• Palliative surgical procedures, such as bypass operations for bile duct or intestinal obstructions, to relieve symptoms like jaundice or nausea

• Radiotherapy to specifically treat pain or control local tumor growth when surgery is no longer possible

At Prof. Büchler’s center, surgeons, oncologists, radiologists, and palliative care specialists work closely together to develop an individualized treatment plan for each patient. The focus is always on the whole person – with the aim not only of gaining more time but of making that time as free from discomfort and as fulfilling as possible.