Pancreatectomy

Pancreatectomy is a surgery to remove all or part of the pancreas. In a total pancreatectomy, part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed.

Types of Pancreatectomy

Total Pancreatectomy:  Surgery to remove the entire pancreas. Part of the stomach, part of the small intestine, the common bile duct, gallbladder, spleen, and nearby lymph nodes also are removed

Distal Pancreatectomy: Removal of the body and tail of the pancreas.

Why is a  performed Pancreatectomy

Pancreatectomy is the most effective treatment for cancer of the pancreas, an abdominal organ that secretes digestive enzymes, insulin, and other hormones. The thickest part of the pancreas near the duodenum (small intestine) is called the head, the middle part is called the body, and the thinnest part adjacent to the spleen is called the tail.

While surgical removal of tumors in the pancreas is preferred, it is only possible in the 10-15% of patients who are diagnosed early enough for a potential cure. Patients who are considered suitable for surgery usually have small tumors in the head of the pancreas (close to the duodenum, or first part of the small intestine),have jaundice as their initial symptom, and have no evidence of metastatic disease (spread of cancer to other sites).

Pancreatectomy is sometimes necessary when the pancreas has been severely injured by trauma, especially injury to the body and tail of the pancreas. While such surgery removes normal pancreatic tissue as well, the long-term consequences of this surgery are minimal, with virtually no effects on the production of insulin, digestive enzymes, and other hormones.

Chronic pancreatitis is another condition for which pancreatectomy is occasionally performed. Chronic pancreatitis--or continuing inflammation of the pancreas that results in permanent damage to this organ--can develop from long-standing, recurring episodes of acute (periodic) pancreatitis. This painful condition usually results from alcohol abuse or the presence of gallstones. In most patients with alcohol-induced disease, the pancreas is widely involved, therefore, surgical correction is almost impossible.

Risks associated with having a Pancreatectomy

The mortality rate for pancreatectomy has improved in recent years to 5-10%, depending on the extent of the surgery and the experience of the surgeon. A study of 650 patients at Johns Hopkins Medical Institution, Baltimore, found that only nine patients, or 1.4%, died from complications related to surgery.

There is still, however, a fairly high risk of complications following any form of pancreatectomy. The Johns Hopkins study documented complications in 41% of cases. The most devastating complication is postoperative bleeding, which increases the mortality risk to 20-50%. In cases of postoperative bleeding, the patient may be returned to surgery to find the source of hemorrhage, or may undergo other procedures to stop the bleeding.

One of the most common complications from a pancreaticoduodenectomy is delayed gastric emptying, a condition in which food and liquids are slow to leave the stomach. This complication occurred in 19% of patients in the Johns Hopkins study. To manage this problem, many surgeons insert feeding tubes at the original operation site, through which nutrients can be fed directly into the patient's intestines. This procedure, called enteral nutrition, maintains the patient's nutrition if the stomach is slow to recover normal function. Certain medications, called promotility agents, can help move the nutritional contents through the gastrointestinal tract.