Pancreatectomy

Overview

A pancreatectomy involves surgically removing the entire or a portion of the pancreas. The pancreas is a component of your digestive system. Its two primary purpose is to produces hormones that assist in controlling blood sugar levels and storing food-derived energy, and produces enzymes which help in the breakdown of food for digestion.

The most common reasons for pancreatectomy are cancer and severe chronic pancreatitis. Your digestive system may suffer permanent effects if all or a portion of your pancreas is removed. You might now need to take digestive enzymes and insulin.

Types

The shape of your pancreas is similar to that of a fish, with a broad “head,” a medium “body,” and a narrower “tail.” The pancreas may be removed in sections, or in whole, depending on the operation. It is occasionally necessary to remove surrounding veins and organs as well.

• Central pancreatectomy: The head and tail of your pancreas remain intact after a central pancreatectomy removes its central body. Rarely recommended because it is a challenging procedure. It is only feasible when you are taking something out locally. However, it can assist maintain more of your pancreatic function and avoid the need for subsequent organ removal when it is feasible.
• Distal pancreatectomy: A distal pancreatectomy involves removing the pancreatic tail and, in some instances, the body as well, if necessary. Your spleen and the tail of your pancreas are closely related organs. During a distal pancreatectomy, your spleen and pancreatic tail are frequently removed.
• Whipple procedure (Pancreaticduodenectomy): During a pancreaticduodenectomy, the duodenum—the portion of the small intestine that attaches to the pancreas—is removed. Your gallbladder and bile duct are removed as well because the common bile duct drains into your duodenum and passes through the head of your pancreas. In order to restore normal digestion, the remaining portion of your small intestine is joined to your pancreas, bile duct, and stomach during the procedure.
• Total pancreatectomy: When condition affects the entire organ or when there is insufficient healthy tissue to preserve it, then the total pancreatectomy is recommended by removing the entire organ. Removing your entire pancreas necessitates the removal of numerous nearby lymph nodes, arteries, and organs. That usually includes your lower abdomen, duodenum, gallbladder, and spleen. After that, the procedure reattaches your small intestine to your stomach and bile duct.

Reasons for undergoing the procedure

The two most frequent causes for which healthcare providers suggest a pancreatectomy are tumors and pancreatitis. When a tumor is removed from the pancreas, the chance of it spreading to other areas of your body is decreased. When your pancreas gets inflamed, you get pancreatitis. Severe discomfort and other consequences may result from it, and this may be a sign that a pancreatectomy is necessary.

A pancreatectomy may be used to treat the following conditions:

• Metastatic kidney cancer.
• Pancreatic cyst or cancer.
• Pancreatic neuroendocrine tumors, such as insulinoma.
• Severe chronic pancreatitis.

Risk

The surgical procedure may include the following risk:

• Anastomotic leak.
• Bleeding.
• Blood clots.
• Infection.

Before the procedure

There could be a few things you need to do in the days leading up to surgery. Among them could be:

• A nurse practitioner will see you for preoperative testing. They will go over your current medications and medical history with you. A chest X-ray or EKG are two common medical procedures that may be performed to ensure your health before the surgery.
• The nurse will also inquire about your present alcohol consumption. It’s important to be truthful in this regard. Drinking alcohol can lead to specific issues both during and after surgery. Any healthcare provider can assist you in stopping safely and provide any required treatment for any withdrawal symptoms.
• Prior to the treatment, you can be given an antiseptic skin cleanser to use. This will assist in avoiding surgical site bacterial infections. Certain medications, like blood thinners and NSAIDs, may need you stop taking them for a few days.

During the procedure

Your anesthesiologist will administer anesthetic through an IV line in your arm when it’s time for surgery, and your healthcare team will assist you onto the operating bed. You’ll go to sleep as a result of the anesthesia. You will still receive fluids, medication, and nourishment through your IV.

While you’re unconscious, the healthcare provider will insert a number of tubes to support your body. There will be a tube in your stomach to stop nausea and one in your windpipe to assist you in breathing. You will have tubes in your abdominal cavity to drain extra fluid, and a Foley catheter to drain urine.

Open surgery is used for the majority of pancreatectomy, providing easy access to multiple organs at once. Some medical facilities might be able to carry out specific pancreatectomy using robotic or minimally invasive surgery techniques like laparoscopic surgery. These techniques facilitate faster recovery.

During open surgery, the abdominal cavity is opened by making a single, lengthy incision across your abdomen. Whether your operation is robotic or laparoscopic, the healthcare provider performing it might make several tiny “keyhole” incisions. They will use a laparoscope and lengthy instruments to perform surgery.

A distal or central pancreatectomy requires four hours to complete. Whipple’s procedure, or a total pancreatectomy, takes roughly six hours.

After the procedure

After the procedure, you will be transferred to a hospital room, and your healthcare team will keep a close eye on your vital signs and general condition. Some of your tubes may still be in place, but they will probably be taken out in the next several days. You may spend a little longer in the hospital than a week.

You will gradually wean off of your on-demand pain medication during your stay. On the first day following surgery, you will be helped out of bed, and each day you will be able to move around a bit more. You’ll move up to more solid foods gradually from a liquid diet. At first, you can feel constipated. 

Following your pancreatectomy, your healthcare team will also be keeping a watch on your blood glucose levels and digestion. They must be aware of your lower pancreatic function and how you are doing. They will make the necessary adjustments to the medications and diet.

Outcome

A pancreatectomy is advised if deemed necessary by your healthcare providers, typically for cases such as pancreatic cancer. This procedure can potentially extend your life and may be the only viable option when other conditions are causing persistent problems.

After a total pancreatectomy, or any pancreatectomy in which a significant portion of the pancreas is removed to affect its functionality, you will experience lasting effects. In addition, issues from losing other organs that require removal during your pancreatectomy could occur. Among these includes the following:

• Diabetes: A partial pancreatectomy can bring the onset of diabetes if too many insulin-producing cells are removed. This occurs in 10% of cases. A total pancreatectomy will bring diabetes in all cases, except when your surgeon is able to successfully transplant the islet cells. Your healthcare provider will prescribe insulin therapy on a sliding scale according to your need.
• Compromised immunity: Your immunity to several infectious diseases will be affected if your spleen is removed during a complete or distal pancreatectomy. As a component of your immune system, the spleen is in charge of producing antibodies that help in the defense against infections. Your healthcare provider could suggest specific vaccinations to help avoid infections after spleen removal.
• Exocrine pancreatic insufficiency: Indigestion and malabsorption are symptoms that occur when the pancreas is unable to produce adequate amounts of pancreatic enzymes. On one end of the range, this may result in pain and diarrhea; on the other, it may result in malnutrition. Depending on your needs, your healthcare provider will recommend pancreatic enzyme replacement therapy (PERT).
• Non-alcoholic fatty liver disease: After a pancreatectomy, changes to your metabolism may cause your liver to store an excessive amount of fat (steatosis). Although it doesn’t usually result in issues, in certain instances, this can develop steatohepatitis, a chronic inflammation of the liver, and progressive liver disease.

Depending on your preoperative condition, the type of surgery you had—open or minimally invasive—and the complexity of the procedure, your recovery at home could take four to eight weeks.

It is recommended to call your healthcare provider if you experience the following:

• Any discharge, redness, or swelling that could indicate an infection at the location of the incision.
• Diarrhea or constipation.
• Fever over 100.4 F. (37.77 degrees Celsius).
• Severe pain.