Pancreatectomy
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, pancreatectomy is performed only as a remedy for life-threatening conditions.
Reasons for Pancreatectomy
Reasons for performing pancreatectomy include the following:
- Severe trauma to the region
- Chronic pancreatitis (inflammation of the pancreas)
- Necrotizing pancreatitis (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)
Pancreatectomy is also be performed to treat cancer of the stomach or large intestine that has metastasized to the pancreas.
Diagnosis of Need for Pancreatectomy
Various techniques are used to diagnose pancreatic disorders that may require 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.
The Pancreatectomy Procedure
There are several types of pancreatectomy: total pancreatectomy, pancreaticoduodenectomy (Whipple procedure), pylorus-sparing pancreaticoduodenectomy, and distal pancreatectomy. Which one is performed depends on the specific nature of the patient's injury or disease.
The patient is usually placed under general anesthesia. Pancreatectomy is performed as open surgery (one large incision) or laparoscopically (four small incisions through which a laparoscope and tiny surgical instruments are inserted). A temporary drain is inserted during surgery to prevent fluid from accumulating. Depending on the type of procedure, part or all of the pancreas is removed; with total pancreatectomy, the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach are also removed.
Depending on the reason for the pancreatectomy and the type of procedure performed, postoperative treatments may be necessary.
Risks of Pancreatectomy
With any surgical procedure there are inherent risks, which include the following:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medication
- Postsurgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
In addition, there are two risks specific to pancreatectomy: delayed gastric emptying, and pancreatic anastomotic leakage. 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 pancreatic anastomotic leakage (leakage that occurs at the point at which the surgeon connected the remaining piece of the pancreas to other structures in the abdomen), further surgery may be necessary.
Recovery from Pancreatectomy
Pancreatectomy is major surgery, and requires an average hospital stay of 2 to 3 weeks. Pain medication is prescribed for abdominal pain. Any implanted tubes are removed when appropriate, and exams are performed to monitor a patient's recovery.
Total pancreatectomy (in which the entire pancreas is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach) results in a condition called "pancreatic insufficiency," which interferes with digestion. As a result, a total-pancreatectomy patient requires pancreatic enzyme replacement, as well as insulin injections.
When the reason for pancreatectomy is malignancy, postoperative chemotherapy and/or radiation may be necessary.
For some pancreatectomy patients, a pancreas transplant is a viable option.