A pancreatectomy is the surgical removal of all or part of the pancreas. The pancreas is an organ about the size of a hand located in the abdomen in the vicinity of the stomach, intestines, and other organs. It lies behind the stomach and in front of the spine. The pancreas has two critical functions in the body:
A pancreatectomy is used to treat a number of conditions involving the pancreas including:
Patients with symptoms of a pancreatic disorder undergo a number of tests before surgery is even considered. These can include ultrasonography, x ray examinations, computed tomography scans (CT scan), and endoscopic retrograde cholangiopancreatography (ERCP), a specialized imaging technique to visualize the ducts that carry bile from the liver to the gallbladder. Tests may also include angiography, another imaging technique used to visualize the arteries feeding the pancreas, and needle aspiration cytology, in which cells are drawn from areas suspected to contain cancer. Such tests are required to establish a correct diagnosis for the pancreatic disorder and in the planning the surgery.
Since many patients with pancreatic cancer are undernourished, appropriate nutritional support, sometimes by tube feedings, may be required prior to surgery.
Some patients with pancreatic cancer deemed suitable for a pancreatectomy will also undergo chemotherapy and/or radiation therapy. This treatment is aimed at shrinking the tumor, which will improve the chances for successful surgical removal. Sometimes, patients who are not initially considered surgical candidates may respond so well to chemoradiation that surgical treatment becomes possible. Radiation therapy may also be applied during the surgery (intraoperatively) to improve the patient's chances of survival, but this treatment is not yet in routine use. Some studies have shown that intraoperative radiation therapy extends survival by several months.
Patients undergoing distal pancreatectomy that involves removal of the spleen may receive preoperative medication to decrease the risk of infection.
Pancreatectomy is major surgery. Therefore, extended hospitalization is usually required with an average hospital stay of two to three weeks.
Some pancreatic cancer patients may also receive combined chemotherapy and radiation therapy after surgery. This additional treatment has been clearly shown to enhance survival rates.
After surgery, patients experience pain in the abdomen and are prescribed pain medication. Follow-up exams are required to monitor the patient's recovery and remove implanted tubes.
A total pancreatectomy leads to a condition called pancreatic insufficiency, because food can no longer be normally processed with the enzymes normally produced by the pancreas. Insulin secretion is likewise no longer possible. These conditions are treated with pancreatic enzyme replacement therapy, which supplies digestive enzymes; and with insulin injections. In some case, distal pancreatectomies may also lead to pancreatic insufficiency, depending on the patient's general health condition before surgery and on the extent of pancreatic tissue removal.
There are risks and side effects related to having a pancreatectomy. Risks and side effects may be:
The hospital stay for a pancreatectomy is often one to three weeks. While in the hospital you may have:
Depending on your situation, you may also have: