Definition and Overview
Pancreatectomy is a surgical procedure that involves the complete or partial removal of the pancreas, a glandular organ that is part of the endocrine and digestive systems. This organ is located in the abdominal cavity, right behind the stomach, and is responsible for the production of a number of hormones that are important to the body’s different processes, including the pancreatic polypeptides, insulin, somatostatin, and glucagon. It is also responsible for the production and secretion of digestive enzymes that aid in the digestive process, facilitate the absorption of nutrients in the human intestine, and assist in breaking down lipids, proteins, and carbohydrates. A pancreas resection procedure is performed to manage conditions affecting the organ, including benign and malignant pancreatic tumours, and pancreatitis.
There are a number of pancreatectomy types, including the following:
- Pancreaticdoudenectomy - Also known as a Whipple procedure, this type of pancreas resection involves several organs, including the duodenum. This is often recommended for patients with malignant pancreatic tumours combined with other cancerous growths in the duodenal papilla, the common bile duct, or the duodenum near the organ.
- Distal pancreatectomy - This involves the removal of the bottom half of the pancreas and is recommended for patients with malignant tumours at the tail or the bottom of the organ.
- Middle segmental pancreatectomy - This is performed on the middle segment of the pancreas.
- Total pancreatectomy - This involves the complete removal of the pancreas.
Who Should Undergo and Expected Results
Pancreas resection is performed for the treatment or management of the following conditions:
Necrosing pancreatitis - This involves the collection of fluids and necrosis in the organ, often as a complication of acute pancreatitis. Over time, the fluid collected in the organ forms a wall, known as a pseudocyst, which has high levels of pancreatic enzymes. When this pseudocyst becomes infected, it turns into a pancreatic abscess. Necrosing pancreatitis can cause sepsis and multiple organ failure. The procedure can prevent the onset of necrosis in the pancreas, which can increase the patient’s chances of survival.
Chronic pancreatitis. This refers to the inflammation of the pancreas that occurs over a longer period of time. A patient with this condition experiences impairment in food digestion and low levels of pancreatic hormones.
Pancreatic trauma. Injuries to the pancreas can be difficult to diagnose, but minor ones are relatively easy to treat. However, when these minor injuries are not diagnosed properly, or in cases of severe pancreatic injuries, the patient can suffer severe symptoms that will be extremely difficult to treat and manage.
Pancreatic ductal adenocarcinoma (PDAC). This type of pancreatic cancer develops from the cell lining the pancreatic ducts responsible for transporting digestive juices into the small bowels. Ductal adenocarcinomas can grow anywhere in the organ, but they are typically found in the head of the pancreas.
- Serous cystadenocarcinoma. Though rare, these cystadenocarcinomas often start out as benign cysts that contain water-like fluids.
- Pancreatic neuroendocrine tumors (NETs). This type of tumour develops from the pancreas’ hormone-producing cells, and typically affects individuals with a family history of von Hippel-Lindau Syndrome and Multiple Endocrine Neoplasia.
- Mucinous cystic neoplasm with invasive carcinoma. These cancer-causing growths often occur in the tail or body of the pancreas, and are usually diagnosed in middle-aged female patients. Unlike other types of pancreatic neoplasms, these growths are filled with thick mucus.
- Acinar cell carcinoma. This type of pancreatic cancer is very rare. It develops in the acinar cells that are responsible for the production and secretion of digestive enzymes. Over time, this type of tumour produces excessive amounts of pancreatic lipase, which assists in the digestion of fats. Distinct symptoms of this cancer include joint pain and skin rashes.
- Severe hyperinsulinemic hypoglycemia. This condition involves high production and secretion of insulin, which results in low blood glucose levels.
How Does the Procedure Work?
There are two ways of performing a pancreas resection: open and laparoscopic surgery. Laparoscopic surgery is often the preferred method as it minimizes the risks and recovery period.
With a laparoscopic pancreatectomy, the surgeon makes four small incisions in the abdomen, which serve as the entry point for thin, tube-like surgical instruments. The patient’s abdomen will be filled with carbon dioxide to help the surgeon view the abdominal cavity through a tiny camera inserted through one of the incisions.
With a partial pancreatectomy, the surgeon will clamp the blood vessels before cutting them. The surgeon will also staple and divide the organ into segments for removal. If the patient’s condition affects the vein or artery of the spleen, this organ will also be removed.
In a total pancreatectomy, the surgeon will remove the whole pancreas, including other organs attached to it (such as the common bile duct). The end of the stomach will be divided and detached, the pancreas (and attached organs) removed, and reconnected to the small intestine.
Any type of pancreatectomy is performed under general anaesthesia.
Possible Risks and Complications
Pancreas resection is linked to several risks and possible complications, including the following:
- Post-operative bleeding, which increases mortality risk by up to 50 percent
- Delayed gastric emptying
- Pancreatic anastomotic leak
Claudius C, Lillemoe KD. Palliative Therapy for Pancreatic Cancer. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014: 481-487.
Jensen EH, Borja-Cacho D, Al-Refaie WB, Vickers SM. Exocrine Pancreas. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 56.