Pancreatectomy

If you are dealing with pancreatic cancer, chronic pancreatitis, or another condition of the pancreas, your doctor may recommend a pancreatectomy. A pancreatectomy, sometimes call pancreatic cancer surgery, is surgery to remove part or all the pancreas. The surgeon carefully separates the pancreas from surrounding organs and removes the targeted section. Reconstruction of the pancreas may be needed to restore digestive function. As with any surgery, there are risks associated. Depending on the extent of the surgery, patient health, and other factors, risks of a pancreatectomy include inflammation, infection, bleeding, and the potential of diabetes. A total pancreatectomy has the highest risk, but your doctor and care team monitor and assess your health after surgery.

There are different types of pancreatectomies based upon how much is removed.

• Total pancreatectomy: Removal of the entire pancreas, part of the small intestine (duodenum), gallbladder, common bile duct, and sometimes part of the stomach.
• Partial pancreatectomy (pancreaticoduodenectomy or Whipple procedure): Removal of the head of the pancreas (where most tumors occur), part of the bile duct, gallbladder, duodenum, and sometimes part of the stomach.
• Distal pancreatectomy: Removal of the body and tail of the pancreas.
• Central pancreatectomy: Removal of the neck of the pancreas while preserving the head and tail.

Reasons for a pancreatectomy

A pancreatectomy is a complex procedure, and due to its potential risks and impact on the body, is only used in specific situations. Since the pancreas is a crucial organ for digestion and hormone production, many factors are considered before a pancreatomy. Some of the most common reasons a pancreatectomy might be recommended include:

• Pancreatic cancer: This is the most common reason for a pancreatectomy. The goal is to surgically remove the cancerous tumor and potentially some surrounding tissue to prevent the cancer from spreading.
• Severe chronic pancreatitis: In cases of chronic pancreatitis (inflammation of the pancreas) that cause debilitating pain or complications unresponsive to other treatments, a pancreatectomy might be considered to relieve symptoms and improve quality of life.
• Pancreatic Neuroendocrine Tumors (NETs): These rare tumors, arising from hormone-producing cells in the pancreas, may require surgical removal to control hormone production and prevent spread.
• Other pancreatic tumors: This category encompasses various benign (noncancerous) or malignant (cancerous) tumors affecting the pancreas, which might call for a pancreatectomy depending on factors like size, location, and potential for malignancy.
• Trauma: In rare cases, severe injury or trauma to the pancreas, such as from a car accident, could require a pancreatectomy to remove damaged tissue and control bleeding.

Why choose AHN for your pancreatectomy

Given the complexity of a pancreatectomy, having a surgical oncologist and a care team who are not only experts in their field but also compassionate can provide the most comprehensive care. The experts at AHN are focused on providing minimally invasive surgeries that employ the latest technologies while seeing you as the individual you are who needs tailored care.

AHN Pancreas Cancer Center of Excellence

The Pancreas Cancer Center of Excellence at AHN Cancer Institute provides high quality, personalized, and exceptional multidisciplinary care to our patients. We diagnose our patients with highly sophisticated and safe techniques using innovative technology. Learn more about our Pancreas Cancer Center of Excellence.

Preparing for your pancreatectomy

A pancreatomy is a major surgery that needs thorough preparation. Your surgeon and care team will go over the specifics with you on what you will need to do, but for the majority of patients surgery preparation includes measures that will help your body during and after surgery to aid in successful recovery. This may include:

• Tests to determine which type of surgery is best
• Limiting or stopping medications such as NASAIDs or blood thinners
• Not drinking alcohol or smoking
• Adjusting your diet

On the day of your pancreatectomy

On the day of your surgery, you will be in caring and skilled hands. Before your surgery, you can often expect the following guidelines to ensure your surgery goes well.

• Do not consume any food or drink. Usually, your care team will instruct you not to have anything to eat or drink after midnight the night before.
• Discuss which, if any, medications or prescriptions you should take before your surgery.
• You will likely be asked to remove any jewelry, makeup, and nail polish.

Before your surgery, you will talk with your surgeon to go over the procedure and meet with the anesthesiologist so they can review your care plan

Pancreatectomy recovery

After surgery, you will be brought into recovery. You’ll likely spend some time in the intensive care unit so the medical professionals can monitor your vital sights and breathing, and administer pain management. Pain is dependent on each patient, but considering the extent of surgery, prepare to experience postoperative pain. Your medical team will provide pain medication intravenously and later by other routes (oral, patient-controlled analgesia (PCA) pump). This will be carefully managed, and steps will be taken so you are comfortable. Here are some additional things to know about recovering from pancreatectomy surgery.

• Drains: You’ll likely have drains placed in your abdomen to remove excess fluid and blood.
• Intravenous Fluids: You’ll receive fluids through your IV to prevent dehydration.
• Nasogastric Tube (NG Tube): This tube might be inserted through your nose and into your stomach to remove stomach contents and prevent nausea and vomiting. It's usually temporary.
• Monitoring: Your vital signs (heart rate, blood pressure, oxygen saturation, temperature) will be monitored closely.
• Breathing exercises: Deep breathing exercises and coughing are essential to prevent pneumonia. A respiratory therapist will guide you.
• Early mobilization: As soon as your condition allows, you'll be encouraged to get out of bed and walk around to prevent complications like blood clots.
• Bowel function: Your bowels might be slow to return to normal function. You may not pass gas or have a bowel movement for a few days.

Long-term management

Your long-term care management will be specific to your needs, health, and type of pancreatectomy surgery. There are some common aspects that all pancreatomy patients will experience when it comes to long-term management.

• Dietary changes:
  • Enzyme Replacement Therapy: A significant portion of the pancreas is removed in most pancreatectomies, leading to insufficient production of pancreatic enzymes crucial for digesting food. Patients will need to take pancreatic enzyme supplements with every meal for the rest of their lives to aid digestion and prevent nutrient deficiencies. Dosage may need adjustment over time.
  • Dietary restrictions: Initially, a low-fat, bland diet might be recommended to reduce digestive stress. Over time, the diet can be adjusted based on tolerance, but some restrictions may remain. Monitoring for malabsorption is crucial.
  • Nutritional monitoring: Regular blood tests to assess nutrient levels (e.g., vitamins, minerals) are necessary to detect and address deficiencies. A registered dietitian can provide guidance on nutrition plans.
• Diabetes management:
  • Insulin therapy: The pancreas produces insulin, so a total or subtotal pancreatectomy often results in diabetes. This requires careful monitoring of blood sugar levels and insulin therapy, either through injections or an insulin pump. Regular HbA1c tests are necessary.
  • Blood glucose monitoring: Frequent monitoring of blood glucose levels is essential to adjust insulin dosage as needed.
• Medication management:
  • Pain management: While acute pain is addressed post-surgery, some patients may experience chronic pain requiring ongoing management. This could involve medications, physical therapy, and other pain-management strategies.
  • Other medications: Depending on other health conditions or complications, additional medications might be needed, such as anti-nausea medication, laxatives, or medication for other existing medical issues.
• Regular follow-up appointments with your surgeon, endocrinologist, gastroenterologist, and other specialists.
• Regular imaging studies to monitor for complications or recurrence of cancer.
• Lifestyle adjustments, including regular physical activity, managing stress, and connecting with support groups to help your emotional health. 

Common pancreatectomy questions

Having questions about a pancreatectomy is common, and your care team, surgeon, and AHN are here to answer those for you.

What type of pancreatectomy am I having, and why?

This depends entirely on your individual diagnosis, as well as the location and extent of the condition being treated. Your AHN Care Team will take into account several factors including:

• If you have cancer: The location, size, type, and stage of the tumor play a significant role. Cancer limited to the body or tail of the pancreas might require a distal or central pancreatectomy.
• If you have chronic pancreatitis: The extent of pancreatic damage and location of blockages or strictures influence the surgical approach.
• Other conditions: Factors like pancreatic cysts, tumors (even benign ones), or trauma dictate the extent of pancreatic tissue needing to be removed.
• Your overall health: The patient’s overall fitness and ability to withstand a major surgery are crucial considerations. Older patients or those with preexisting conditions might not be suitable for extensive procedures like a Whipple.

What are the risks and potential complications of a pancreatectomy?

The specific risks vary based on the type of pancreatectomy, your overall health, and other factors unique to you. Your surgeon will explain the potential complications relevant to your case.

It’s important to understand that every surgical procedure carries inherent risks and potential complications. 

General risks (applicable to all types of surgery to varying degrees) include:

• Bleeding: Any surgery involving major organs has a risk of bleeding.
• Infection: Infection can occur at the surgical site or elsewhere in the body.
• Pancreatic fistula: A leak of pancreatic fluid from the pancreas or the connection site, which can be a serious complication.
• Delayed gastric emptying (Gastroparesis): The stomach empties slowly, leading to nausea, vomiting, and feeling full quickly.
• Postoperative diabetes: Especially after total pancreatectomy, as the pancreas produces insulin.
• Weight loss and malnutrition: Difficulty digesting food and absorbing nutrients.

A Whipple procedure, or pancreaticoduodenectomy, can also include post-Whipple Syndrome. This is a group of symptoms like diarrhea, dumping syndrome (rapid gastric emptying), weight loss, and nutritional deficiencies.

A total pancreatectomy could lead to diabetes that will require lifelong insulin therapy. There are other significant digestive challenges including the complete loss of pancreatic enzymes, which may be treated with enzyme replacement therapy and dietary modifications.

Distal pancreatectomy and central pancreatectomy procedures are less likely to lead to diabetes than total pancreatectomy. However, these procedures can still raise your risk of getting diabetes.

Can a person live without a pancreas?

While the pancreas is a vital organ, it is possible to live without it. Doing so requires lifelong medical care to manage the health conditions that arise from not having a functioning pancreas.

People without a pancreas are unable to produce insulin or crucial digestive enzymes. Insulin injections regulate blood sugar levels and reduce the risk of diabetes. Enzyme replacement therapy can aid in digestion and nutrient absorption.

Living without a pancreas presents significant challenges, but with proper medical management, individuals can lead relatively normal lives.

What can I eat after pancreatectomy surgery and when can I return to a regular diet?

While recovering from surgery, you will most likely be on a liquid diet for several days. Dietary recommendations after pancreas surgery are highly individualized and should be determined by a health care professional, preferably a registered dietitian. These recommendations often include:

• Smaller, more frequent meals aid digestion and manage blood sugar.
• Lower fat intake, as fat digestion can be challenging.
• Staying hydrated and drinking plenty of fluids.
• Limiting certain foods initially.

Contact us

Please call (833) 246-7662 to make an appointment directly with the Surgical Oncologist that has the focus for your specific needs.