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 can be partially or fully removed, depending on the specific procedure. It is occasionally necessary to remove surrounding vessels and organs as well.

• Central pancreatectomy: The head and tail of your pancreas remain intact after a central pancreatectomy removes its central body. This complex surgery is rarely necessary and is typically only viable for removing localized issues. However, when feasible, it helps preserve more pancreatic function and avoids the need for removing other organs.
• Distal pancreatectomy: A distal pancreatectomy involves removing the pancreatic tail and, if necessary, the body of the pancreas as well. Your spleen and the tail of your pancreas are closely related organs. During a distal pancreatectomy, your pancreatic tail and spleen are frequently removed.
• Whipple procedure (pancreaticduodenectomy): During a pancreaticduodenectomy, the duodenum—the portion of the small intestine that attaches to the pancreas—is removed. Since the common bile duct passes through the head of the pancreas and drains into the duodenum, the bile duct and gallbladder are also removed. The Whipple procedure ends with the reattachment of the remaining pancreas, bile duct, and stomach to the small intestine to ensure normal digestion. 
• Total pancreatectomy: When a condition affects the entire pancreas or there is not enough healthy tissue left to preserve it, a total pancreatectomy is recommended, which involves removing the entire organ. This procedure also requires the removal of several nearby lymph nodes, vessels, and organs, often including the lower part of the stomach, duodenum, gallbladder, and spleen. Following this, the small intestine is reconnected to the 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 pain and other consequences may result from it, and this may be an indication that a pancreatectomy is necessary.

A pancreatectomy may be used to treat the following conditions:

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

Risks

The surgical procedure may include the following risk:

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

After the procedure, you may experience several short-term side effects:

• Paralytic ileus: Your bowels might not function for a few days after surgery. This is normal, and during this time, you’ll stay on a liquid diet until your bowels start moving again.
• Delayed gastric emptying: Your stomach might also take longer than usual to release food into your intestines. In some cases, medications called prokinetics may be needed to help with this.
• Dumping syndrome: If your procedure involved removing or reconstructing the lower part of your stomach (pyloroplasty), you might experience dumping syndrome. This condition occurs when your modified pylorus doesn’t regulate the passage of food from your stomach to your small intestine effectively, causing food to enter the intestine too quickly (rapid gastric emptying). This can lead to various gastrointestinal symptoms after eating. While this side effect is usually temporary, it can typically be managed with dietary changes.
• Weight loss: It’s common to lose 10 to 15 pounds after a pancreatectomy, due to changes in diet and the way your digestive system functions. As you and your healthcare provider adjust to these changes, your weight should stabilize.

After a total pancreatectomy, or any pancreatectomy in which a significant portion of the pancreas is removed to affect its functionality, you will experience long-term effects. Additionally, complications may arise from the removal of other organs during the procedure. Among these includes the following:

• Diabetes: A partial pancreatectomy may lead to the onset of diabetes if too many insulin-producing cells are removed, which happens in about 10% of cases. In contrast, a total pancreatectomy will result in diabetes in all cases unless your surgeon successfully transplants the islet cells. Your healthcare provider will prescribe insulin therapy based on your individual needs, using a sliding scale approach.
• Exocrine pancreatic insufficiency: Indigestion and malabsorption are conditions that occur when the pancreas is unable to produce adequate amounts of pancreatic enzymes. This can range from causing discomfort and diarrhea to leading to malnutrition. Depending on your needs, your healthcare provider will recommend pancreatic enzyme replacement therapy (PERT).
• Compromised immunity: Your immunity to several infectious diseases will be affected if your spleen is removed during a total 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.
• 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.

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 perform certain pancreatectomy procedures using minimally invasive techniques, such as robotic or 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. 

Recovery at home can take between four to eight weeks, depending on your overall health before the surgery, the extent of the procedure, and whether you underwent minimally invasive or open surgery.

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.