Pancreatectomy

概述

A pancreatectomy is surgery to remove part or all of the pancreas. The pancreas is an organ behind the stomach. It makes enzymes that help digest food. It also makes hormones, including insulin and glucagon, that help manage blood sugar.

Pancreatectomy, also called pancreas removal surgery, may be used to treat pancreatic cancer, pancreatic cysts, other tumors and some cases of pancreatitis. How much of the pancreas is removed depends on the condition being treated and which part of the pancreas is affected.

Some types of pancreatectomy remove part of the pancreas. Other types remove the entire pancreas. Nearby organs or tissues also may need to be removed.

After part of the pancreas is removed, some people develop diabetes or have trouble digesting food. After the entire pancreas is removed, insulin is needed for life to manage blood sugar. Pancreatic enzyme medicine also is needed to help digest food.

Types

The pancreas has several parts, including the head, neck, body and tail. The type of pancreatectomy you need depends on which part of the pancreas is affected and how much needs to be removed.

Types of pancreatectomy include:

• Distal pancreatectomy. This surgery removes the tail and part of the body of the pancreas. The spleen also may be removed.
• Pancreaticoduodenectomy, also called the Whipple procedure. This surgery removes the head of the pancreas. The surgeon also removes the first part of the small intestine, called the duodenum, along with the gallbladder and part of the bile duct. Sometimes part of the stomach is removed.
• Central pancreatectomy. This surgery removes part of the body of the pancreas while leaving the head and tail. It may be used for some tumors in the neck or body of the pancreas. Keeping more of the pancreas may help it continue to make digestive enzymes and control blood sugar.
• Total pancreatectomy. This surgery removes the entire pancreas. The surgeon typically also removes the duodenum, gallbladder, spleen and part of the bile duct.

Total pancreatectomy with islet autotransplantation

For some people with chronic pancreatitis, total pancreatectomy may be combined with islet autotransplantation. This combined procedure is called total pancreatectomy with islet autotransplantation (TPIAT).

After the pancreas is removed, insulin-producing cells called islet cells are collected from the pancreas. The cells are then put back into the body, most often in the liver. The goal is to preserve some of the body's ability to make insulin.

TPIAT may preserve some of the body's ability to make insulin. Some people still need insulin after surgery.

目的

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

• Pancreatic cancer. Surgery may be an option when the cancer can be completely removed. The type of surgery depends in part on where the cancer is and whether it affects nearby tissues.
• Pancreatic cysts and precancerous growths. Some pancreatic cysts have features that raise the risk of cancer. One type, called an intraductal papillary mucinous neoplasm, can develop changes that may lead to cancer. Surgery may be recommended 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. The type of surgery depends on the type, size and location of the tumor.
• Chronic pancreatitis. This is long-lasting inflammation of the pancreas. Pancreatectomy may be an option for severe pain that hasn't improved with other treatments. For some people, total pancreatectomy may be combined with islet autotransplantation.

Sometimes a small tumor can be removed while leaving the surrounding pancreas in place. This procedure is called enucleation. It may be an option for some small tumors that don't involve the main pancreatic duct.

Pancreatectomy for pancreatic cancer

Pancreatectomy may be an option for pancreatic cancer that hasn't spread to other parts of the body. Whether surgery is an option also depends on where the cancer is.

Some pancreatic cancers involve nearby blood vessels, which can make the cancer harder to remove completely. In these cases, treatment may start with chemotherapy, sometimes combined with radiation therapy. After treatment, the care team checks whether the cancer can be removed with surgery.

Removing the entire pancreas usually isn't needed if a partial pancreatectomy can remove all of the cancer. Total pancreatectomy may be an option if a partial pancreatectomy isn't enough.

风险

Pancreatectomy has a risk of complications. Your risk depends on your overall health, the type of pancreatectomy and how much tissue is removed.

Complications include:

• Bleeding. Bleeding can happen during or after surgery.
• Infection. An infection can happen at the surgical cut or in the area where surgery was done.
• Pancreatic fistula. This is a leak of pancreatic fluid from the remaining pancreas or from the place where the pancreas is joined to the digestive tract. The risk varies by the type of pancreatectomy.
• Delayed stomach emptying. The stomach may take longer than usual to move food into the small intestine. This can cause nausea or vomiting.
• Diabetes. Diabetes can develop after part of the pancreas is removed. Removing the entire pancreas causes diabetes because the body can no longer make insulin. Lifelong insulin treatment is needed after total pancreatectomy.
• Trouble digesting food. Removing part of the pancreas can make it harder to digest food. This can happen if the remaining pancreas doesn't make enough digestive enzymes. After total pancreatectomy, pancreatic enzyme medicine is needed to help digest food.

Your care team takes steps to prevent complications and checks you closely after surgery. These steps may include medicines to prevent infection and blood clots. If your spleen is removed, vaccines can help protect against some serious infections.

如何进行准备

Your healthcare team gives you instructions based on the type of surgery, the condition being treated and your overall health.

Before surgery, your care team may ask you to:

• Review your medicines. 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 surgery includes removal of the spleen, vaccines can help protect against some serious infections. Your care team tells you which vaccines you need and when to get them.
• 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.

If you're having a total pancreatectomy, your care team helps you prepare for the changes that happen when the entire pancreas is removed. Before surgery, you may meet with dietitians and specialists in diabetes. They can help you learn how to use insulin, manage your blood sugar and take pancreatic enzyme medicine after total pancreatectomy.

Follow your care team's instructions about when to stop eating and drinking before surgery. If you have questions about how to prepare, ask your care team.

可能出现的情况

Before the procedure

Before pancreatectomy, your healthcare team checks your heart rate, blood pressure, breathing rate and temperature. An IV line placed in a vein gives you fluids and medicines.

Pancreatectomy is done using general anesthesia. General anesthesia is medicine that puts you in a sleeplike state during the surgery. You don't feel pain during the procedure.

After the anesthesia takes effect, your care team may place a tube through your nose and into your stomach. This is called a nasogastric tube. It helps keep your stomach empty. Your care team also may place a tube called a urinary catheter into your bladder. The catheter drains urine during and after surgery.

During the procedure

What happens during pancreatectomy depends on the type of surgery you're having and the condition being treated.

Pancreatectomy can be done using open surgery or minimally invasive surgery. Open surgery uses one larger cut in the belly. Minimally invasive surgery is done through several smaller cuts, using a camera and surgical tools. Minimally invasive surgery may be laparoscopic or robotic.

The surgeon removes part or all of the pancreas. Nearby organs or tissues also may be removed. What is removed depends on the type of pancreatectomy and the condition being treated.

If part of the digestive tract is removed, the surgeon reconnects the remaining parts. This allows food and digestive fluids to continue moving through the digestive system.

The surgeon may place one or more drains near the surgical area. These thin tubes remove fluid that collects after surgery.

After the procedure

After pancreatectomy, you're taken to a recovery area. Your care team checks you as you wake from anesthesia. Then you're moved to a hospital room.

Your care team gives you medicine to help manage pain. You'll be encouraged to get out of bed and take short walks as soon as you're able. Walking helps with recovery.

You'll slowly start drinking and eating again. You may begin with liquids and start eating other foods as your digestive system recovers. If you can't eat enough, your care team can give you nutrition through a feeding tube or a vein for a time.

You may have one or more drains near the area where you had surgery. The drains remove fluid that collects after surgery. Often drains are removed before you leave the hospital.

If you need insulin or pancreatic enzyme medicine after surgery, your care team teaches you how to use them. You also may meet with a nutrition specialist.

How long you stay in the hospital depends on the type of pancreatectomy and how your recovery goes. After you leave the hospital, recovery can take several weeks. It's common to feel tired at first. You can slowly increase your activity as you recover. Avoid heavy lifting and strenuous activity until your care team says it's OK. Ask when you can return to work, drive and resume other activities.

Follow your care team's instructions for caring for your surgical cut. Contact your care team if you have signs of infection, such as more pain or swelling, new or increased drainage from the surgical cut, or a fever.

结果

What you can expect after pancreatectomy depends on how much of your pancreas is removed.

After a partial pancreatectomy, some people develop diabetes or have trouble digesting food. People who develop diabetes may need insulin. Those who have problems digesting food may need pancreatic enzyme medicine.

You can live without a pancreas. After a total pancreatectomy, your body can no longer make insulin or pancreatic digestive enzymes. You need insulin for the rest of your life to manage your blood sugar. You also need pancreatic enzyme medicine with meals and snacks to help digest food and take in nutrients.

After total pancreatectomy with islet autotransplantation (TPIAT), the transplanted islet cells may make some insulin. Some people still need insulin after the procedure.

When pancreatectomy is done to treat pancreatic cancer, surgery may be only part of your cancer treatment. After you recover, you may need chemotherapy to help lower the risk of the cancer coming back.