Pancreatectomy

Panorama general

Pancreatectomy is surgery to remove part or all of the pancreas. It is most often done to treat pancreatic cancer. It also may be used to treat chronic pancreatitis and other conditions that affect the pancreas, including tumors and cysts that are not cancer.

The pancreas is an organ behind the stomach. It makes enzymes that help the body digest food. It also makes hormones, including insulin, that help control blood sugar.

The pancreas has several parts, including the head, neck, body and tail. There are several types of pancreatectomy surgery. The type you have depends on the condition being treated and the part of the pancreas that is affected.

Removing part of the pancreas can affect how your body digests food and controls blood sugar. If the entire pancreas is removed, lifelong treatment with pancreatic enzyme medicines and insulin is needed.

Types

Types of pancreatectomy include:

• Distal pancreatectomy. The surgeon removes the tail and part of the body of the pancreas. The spleen also may be removed.
• Pancreaticoduodenectomy, also called the Whipple procedure. The surgeon removes the head of the pancreas and the first part of the small intestine, called the duodenum. The surgeon also removes the gallbladder and part of the bile duct. Sometimes part of the stomach is removed.
• Central pancreatectomy. The surgeon removes part of the neck or body of the pancreas and leaves the head and tail in place.
• Total pancreatectomy. The surgeon removes the entire pancreas. The duodenum, gallbladder, spleen and part of the bile duct typically also are removed.

Total pancreatectomy with islet autotransplantation

For some people with chronic pancreatitis, a total pancreatectomy may be combined with islet autotransplantation.

After the pancreas is removed, insulin-producing cells called islet cells are collected from it. The cells are then put back into the body, most often in the liver. This may help the body continue to make some of its own insulin. Some people still need insulin after surgery.

Por qué se hace

Pancreatectomy may be done to treat cancer and other conditions of the pancreas:

• Pancreatic cancer. Pancreatectomy may be an option when the cancer hasn't spread to other parts of the body and can be removed.
• Pancreatic cysts. Some pancreatic cysts can develop into cancer. Surgery may be advised when a cyst has features linked to a higher risk of cancer.
• Pancreatic neuroendocrine tumors and other tumors. Pancreatectomy may be used to remove some cancerous and noncancerous tumors of the pancreas.
• Chronic pancreatitis. Pancreatectomy may be an option for severe pain that hasn't improved with other treatments.

For some pancreatic cancers, chemotherapy may be given before surgery. Radiation therapy also may be used. After treatment, the care team checks whether surgery is an option.

Riesgos

Pancreatectomy can have complications. Your risk depends on your overall health, the type of pancreatectomy and the condition being treated.

Possible complications include:

• Bleeding, infection and blood clots. These are possible complications after any major surgery.
• Pancreatic fistula. This is a leak of pancreatic fluid after surgery. It can happen where the pancreas was cut or where it was joined to the digestive tract.
• Delayed stomach emptying. The stomach may take longer than usual to move food into the small intestine. This can cause nausea or vomiting.

Changes in blood sugar and digestion

Removing part of the pancreas can affect how your body digests food and controls blood sugar. Some people have trouble digesting food and may need pancreatic enzyme medicine. Some people develop diabetes and may need medicine to control their blood sugar.

When the entire pancreas is removed, your body can no longer make insulin or pancreatic digestive enzymes. You need insulin and pancreatic enzyme medicine for the rest of your life.

Cómo prepararte

Before surgery, you may need to:

• Tell your care team about all medicines, vitamins and supplements you take. You may need to stop taking or change some medicines before surgery. Follow your care team's instructions about when to make these changes.
• Stop smoking and using other nicotine products. Nicotine can slow healing and raise the risk of complications. Ask your care team for help if you need support to stop.
• Get certain vaccines if your spleen is being removed. The spleen helps the body fight infection. If your spleen is being removed, vaccines can help protect against some serious infections. Your care team tells you which vaccines you need and when to get them.
• Follow instructions about eating and drinking. Your care team tells you when to stop eating and drinking before surgery.
• Plan for your recovery. Arrange for someone to help you after you leave the hospital. You may need help with transportation, meals, medicines and other daily activities. Ask your care team how much time you may need away from work or school.

Preparing for total pancreatectomy

If you're having a total pancreatectomy, your care team helps you prepare for life without a pancreas. Before surgery, you may meet with a dietitian and members of your care team who specialize in diabetes. Your team helps you learn how to use insulin, control your blood sugar and take pancreatic enzyme medicine.

Qué esperar

Before the procedure

Before surgery, your care team talks with you about the procedure and answers your questions. A healthcare professional places an IV in a vein to give you fluids and medicines.

Pancreatectomy is done using general anesthesia. General anesthesia is medicine that puts you in a sleeplike state during the surgery.

During the procedure

The surgeon may perform pancreatectomy using open or minimally invasive surgery. In open surgery, the surgeon reaches the pancreas through one larger cut in the belly. In minimally invasive surgery, the surgeon works through several smaller cuts.

Minimally invasive surgery may be laparoscopic or robotic. In laparoscopic surgery, the surgeon uses a small camera and surgical tools. In robotic surgery, the surgeon controls robotic surgical tools from a console.

The surgeon removes part or all of the pancreas, depending on the type of pancreatectomy. Nearby organs or tissues also may need to be removed.

The surgeon may place one or more thin tubes called drains near the surgical area. The drains allow fluid to leave the body after surgery.

After the procedure

After surgery, your care team checks your surgical cut. You receive medicine to help ease pain. Your care team also checks your blood sugar and watches for complications.

You'll slowly start drinking and eating again as your digestive system recovers. Your care team encourages you to get out of bed and take short walks as soon as you're able. Walking helps with recovery.

You may have one or more drains near the area where you had surgery. The drains are removed before you leave the hospital.

How long you stay in the hospital depends on the type of pancreatectomy and how well your recovery goes. Before you leave, your care team gives you instructions for continuing your recovery at home.

Follow your care team's instructions for caring for your surgical cut. Contact your care team if you have fever, chills, more swelling, new or more drainage from the cut, or pain that doesn't get better with pain medicine.

Estudios clínicos

Explora los estudios de Mayo Clinic de pruebas y procedimientos para ayudar a prevenir, detectar, tratar o controlar las afecciones.