Pancreatectomy
A pancreatectomy is the surgical removal of all or part of the pancreas. Because the pancreas is an important organ, essential to both the digestive and endocrine systems, a pancreatectomy is only performed as a remedy for life-threatening conditions.
Reasons for a Pancreatectomy
Reasons for performing a pancreatectomy include:
- Severe trauma to the region
- Chronic pancreatitis, or inflammation of the pancreas
- Necrotizing pancreatitis, in which pancreatic tissue begins to die
- Cancer of the pancreas, duodenum or bile duct, or certain cancers of the blood
- Neoplasm, an overgrowth of cells, which may or may not be malignant
- Insulinomas, hormone-secreting tumors
A pancreatectomy may also be performed to treat cancer of the stomach or large intestine that has metastasized to the pancreas.
Types of Pancreatectomy Procedures
Total Pancreatectomy
A procedure in which case the entire pancreas is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach.
Pancreaticoduodenectomy
The most common surgical pancreatectomy is a pancreaticoduodenectomy, otherwise known as a Whipple procedure. It is a major surgical operation involving the pancreas and duodenum and, if necessary, part of the stomach. This operation is performed to treat cancerous tumors on the head of the pancreas, the bile duct, or the duodenum near the pancreas. After this procedure, the patient will develop Type1 diabetes and become insulin-dependent.
Pylorus-Sparing Pancreaticoduodenectomy
This surgical procedure is gaining in popularity. Its chief advantage is that the pylorus, the part of the stomach that connects to the duodenum, is preserved so the stomach can empty normally.
Distal Pancreatectomy
In this procedure, only the body and tail of the pancreas are removed, leaving the head of the pancreas intact. A distal pancreatectomy is most frequently performed when a malignancy is confined to the end of the pancreas, but is also used to treat chronic pancreatitis or traumatic injury to the pancreas.
Depending on the reason for the pancreatectomy and the type of procedure performed, postoperative treatments may be necessary.
Diagnosis of Need for a Pancreatectomy
Various techniques are used to diagnose pancreatic disorders that may require a pancreatectomy. Among these are X-rays, ultrasound and tomography. Endoscopic retrograde cholangiopancreatography (ERCP) may be used to view the ducts carrying bile from the liver to the gallbladder. Angiography, an imaging technique used to view the arteries that feed the pancreas, and needle aspiration cytology, which is performed to confirm the presence of cancer cells, may also be used.Risks of a Pancreatectomy Procedure
With any surgical procedure there are inherent risks. A pancreatectomy is a relatively high-risk operation. After any surgery, patients are at risk of
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Postsurgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
In addition, there are two risks particularly common after a pancreatectomy: delayed gastric emptying and pancreatic anastomic leak, a leak where the surgeon has connected the remaining piece of the pancreas to other structures in the abdomen. If delayed gastric emptying occurs, a feeding tube may be temporarily implanted until administered medication is able to speed up the digestive process. In the case of leakage, further surgery may be necessary.
Recovery from a Pancreatectomy
A pancreatectomy is major surgery and requires an average hospital stay of 2 to 3 weeks. Patients will have postoperative exams to remove implanted tubes and monitor recovery. They will also be prescribed pain medication for abdominal pain.
A total pancreatectomy creates a condition called pancreatic insufficiency that interferes with digestion. A patient who has undergone this procedure will, therefore, be required to have pancreatic enzyme replacement, as well as insulin injections. When the reason for a pancreatectomy is a malignancy, postoperative chemotherapy and/or radiation may be necessary. For some patients who have undergone pancreatectomy, a pancreas transplant may be a viable option. chemotherapy or radiation.