Pancreatectomy: Procedure, Advantages, Recovery

Choose the content to read

• Why pancreatectomy?
• Symptoms indicating abnormalities of the pancreas?
• What is the diagnosis before pancreatectomy?
• What is the pancreatectomy procedure?
• What is the advantage of pancreatectomy?
• Pancreatectomy at MedPark Hospital

Pancreatectomy

Pancreatectomy is a pancreatic surgery that involves removing part or all parts of the pancreas to treat pancreatic disease or abnormality of the pancreas, including benign pancreatic tumors, pancreatic cancers, or distal bile duct cancers, which may be caused by biliary and pancreatic duct obstruction, autoimmune disorders, genetics, or heavy alcohol consumption, resulting in severe epigastric pain radiating to the back, jaundice (yellowish eyes and skin), weight loss, and intermittent fever. If left untreated, it can lead to serious complications such as fibrosis or pancreatic tumors infiltrating adjacent organs, cystic tumors of the pancreas, acute diabetes, or metastatic pancreatic cancer. Pancreatectomy helps treat pancreatic disease or abnormalities, reduces complications, and improves the chances of curing early-stage pancreatic cancer.

Why pancreatectomy?

Chronic pancreatitis interferes with the production of digestive enzymes and blood sugar-regulating hormones, leaving the body unable to adequately digest food and control sugar levels, resulting in acute diabetes, fibrosis that may obstruct the biliary duct, and an increased risk of pancreatic cancer. Malignant pancreatic tumors will gradually enlarge and compress nearby organs, causing blockage of the pancreatic ducts, biliary ducts, or duodenum, resulting in severe epigastric pain under the right ribcage radiating through the back, jaundice (yellowish eyes and skin), nausea, vomiting, fever, and rapid weight loss.

Pancreatectomy effectively removes precancerous tumors before progressing to cancer, treats chronic pancreatitis, prevents nearby inflammation of the nearby organs, and inhibits early-stage pancreatic cancer from progressing to metastatic cancer, relieving pain, increasing survival rates, and extending life expectancy.

Symptoms indicating abnormalities of the pancreas?

• Chronic epigastric pain that comes and goes for more than 2 weeks or epigastric pain at night
• Dull abdominal pain similar to gastritis
• Dull abdominal pain radiates to the back
• Heartburn, bloating
• Jaundice, yellowish eyes and skin
• Tea-colored urine, dark-colored urine
• Clay-colored stool
• Itchy skin 
• Loss of appetite
• Nausea, vomiting
• Bloating, early satiety
• Chronic diarrhea
• Oily stools
• Weight loss
• Intermittent fever
• Possible bone pain
• Onset of diabetes in the elderly

What diseases can pancreatectomy treat?

• Pancreatic neuroendocrine tumors (NETs)
• Insulinoma (Neuroendocrine tumor)
• Pancreatic cancer 
• Distal bile duct cancers (Cholangiocarcinoma)
• Duodenal cancer
• Ampulla of Vater cancer
• Cystic tumors of the pancreas
• Metastatic kidney cancer metastasizes to the pancreas
• Severe chronic pancreatitis
• Chronic pancreatitis

What is the diagnosis before pancreatectomy?

• The gastroenterologist will conduct a thorough history, physical examination, blood tests, and an abdominal ultrasound CT and/or MRI, or UGI endoscopy to look for tumors, cysts, or pancreatic and biliary cancers. In addition, the gastroenterologist may order PET/CT scans to determine the cancer stage if detected, depending on the doctor's discretion.
• The gastroenterologist will schedule additional physical examinations the day before surgery to assess the patient's physical readiness, as follows:
  • EKG/ECG (Electrocardiogram)
  • Chest X-ray

What is the pancreatectomy procedure?

Pancreatic surgeons will consider pancreatectomy techniques based on each individual, such as open pancreatectomy or a combination of surgical techniques, such as laparoscopic MIS surgery to yield small incisions, less pain, and faster recovery, or robotic-assisted surgery, depending on the pancreatic surgeon, the complexity, and the location of the pancreatic pathologies. The enlarged part of the pancreas is referred to as the head of the pancreas, the center of the pancreas is referred to as the body of the pancreas, and the smaller or narrower end of the pancreas is referred to as the tail of the pancreas.

During the surgery, the pancreatic surgeon may consider removing nearby organs where cancer cells have spread, at the doctor's discretion.

Preoperative pancreatectomy procedures

• For at least 7 days, stop taking antiplatelet drugs such as aspirin, ibuprofen, or Plavix.
• Those with a history of drug allergies. *Must notify the doctor in advance.
• At least 6 hours before surgery, avoid drinking, eating, and smoking.

Pancreatectomies on each surgical technique

1. Pancreaticoduodenectomy (Whipple procedure): In those the pancreatic surgeon found pancreatic cancer has spread to the head of the pancreas, the pancreatic surgeon will determine the Whipple procedure, which involves removing the head of the pancreas, the distal bile duct, the gallbladder, the distal stomach, and the duodenum. The cut ends of the remaining organs will be reconstructed to restore intestinal tract continuity and allow bile and digestive enzymes to enter the small intestine. After the surgery, the gastroenterologist will prescribe enzyme supplements to aid digestion and insulin.
2. Distal pancreatectomy: The pancreatic surgeon will perform a distal pancreatectomy, which involves removing the body of the pancreas, the tail of the pancreas, the spleen, and a part of the distal stomach in some cases, using laparoscopic distal pancreatectomy techniques or robotic-assisted surgery to enable less blood loss, recover quickly, reduce pain, and require a short hospital stay.
3. Distal pancreatectomy with splenic preservation: The pancreatic surgeon will determine distal pancreatectomy with splenic preservation for pancreatic cancer of the body and tail, excluding the spleen, using a laparoscopic distal pancreatectomy technique or robotic-assisted surgery for those who detect non-cancerous tumors. This surgical technique minimizes organ loss, loses less blood, alleviates pain, speeds up recovery, and requires shorter hospitalization.
4. Enucleation of tumor: Suppose the pancreatic surgeon diagnoses the pancreatic tumor as noncancerous. In that case, they may consider enucleation of the tumor, which involves surgically removing only the benign pancreatic tumors, eliminating the need to remove lymph nodes, as is frequently the case with insulinomas.
5. Total Pancreatectomy: In case the tumor or cancer has spread throughout the pancreas, the pancreatic surgeon will consider a total pancreatectomy, which involves removing the entire pancreas, gallbladder, spleen, and distal bile duct, a part of the distal stomach, and duodenum. During a total pancreatectomy procedure, the whole pancreas is surgically removed, resulting in the loss of islet cells, which produce insulin and glucagon, the hormones that regulate blood sugar levels, and pancreatic exocrine glands making digestive enzymes. Losing islet cells may eventually lead to brittle diabetes. To address the concern, the gastroenterologist will prescribe digestive enzymes to aid digestion and insulin for blood sugar control. However, highly skilled pancreatic surgeons in leading hospitals may preserve islet cells during the surgery or even perform islet cell transplantation successfully.

Postoperative pancreatectomy procedures

• After the pancreatectomy, patients will be transferred to the intensive care unit (ICU) for 1-2 weeks to monitor their symptoms and any abdominal infections that may occur.
• The gastroenterologist will prescribe pain relievers and medications to prevent complications.
• Patients may experience constipation in the first few weeks after surgery; the gastroenterologist will prescribe medication to alleviate symptoms and may recommend dietary changes.
• Patients will be transferred to a regular ward for another 1-2 weeks to continue their recovery and take care of their nutrition.
• If the patient's recovery progresses without serious complications, the gastroenterologist will discharge them to go home, depending on the pancreatectomy techniques.
• Gastroenterologists, rehabilitation physicians, and physical therapists will schedule regular appointments to help patients regain normal body function.
• Endocrinologists and nutritionists collaborate to monitor blood sugar levels and digestive function and may prescribe enzyme supplements and insulin to aid recovery. However, in the long run, most people undergoing a pancreatectomy can live without using blood sugar control medications.

What is the risk complication of pancreatectomy?

Complications associated with pancreatectomy that may occur within 48 hours after the surgery include bleeding, infection, and anastomotic leakage of the reconstructed pancreas, biliary tract, stomach, or intestines. If symptoms are detected, the gastroenterologist will initiate prompt treatment as soon as possible.

However, the main complication of pancreatectomy is acute diabetes (type 1 diabetes), caused by the body's loss of glucagon and insulin hormones, which help regulate blood sugar levels. To treat the symptoms, the gastroenterologist will prescribe enzyme supplements and insulin as substitutes. The other common complications following a pancreatectomy include weight loss, constipation, etc.

What is the advantage of pancreatectomy?

• Pancreatic Cancer Treatment: Pancreatectomy is regarded as an effective and precise treatment for pancreatic cancer. In those who have been diagnosed with early-stage pancreatic cancer, pancreatectomy can help remove cancerous cells and prevent them from spreading to other bodily organs and the lymphatic system. In advanced-stage pancreatic cancer, the oncologist may consider a combination treatment of pancreatic surgery with chemotherapy and radiotherapy. In addition, in some non-cancerous pancreatic tumors that have a high risk of becoming cancerous, such as cystic tumors of the pancreas, pancreatectomy is an excellent way to prevent future cancer.
• Chronic Pancreatitis Treatment: If an inflammatory mass is discovered in the pancreas, the pancreatic surgeon will consider performing a pancreatectomy to remove the inflammatory mass from the body, the primary cause of severe epigastric pain. To treat the symptoms, the pancreatic surgeon will perform surgery in conjunction with medications and behavior modification, such as quitting alcohol and smoking.
• Cancerous Tumor Treatment: If a pancreatic tumor, cyst, or pancreatic fluid collection is diagnosed as malignant, the pancreatic surgeon will consider pancreatectomy after examining the tissue biopsy and discovering significant cellular changes in the sample tissue. Potential cancerous pancreatic tumors such as neuroendocrine tumors, tumors larger than 2 cm, high-risk cysts, or pancreatic fluid collection. Pancreatectomy aids in the removal of tumors and the prevention of cancerous growth.
• Islet Cell Transplantation: In those with pancreatic disease, the pancreas is damaged and loses digestive enzymes and insulin. Aside from removing pancreatic diseases, pancreatectomy can also transplant islet cells, the pancreatic cells that help produce digestive enzymes and insulin hormones that control blood sugar levels. Islet cell transplantation helps relieve symptoms related to type 1 diabetes and keeps the sugar levels under control.
• Improve the Quality of Life: Pancreatic cancer and pancreatic tumors cause severe epigastric pain, jaundice, nausea, and vomiting, which significantly affect daily life. Pancreatectomy treats these symptoms at their source, stops cancer from spreading, prevents rapid-onset diabetes, and significantly improves the quality of life.

Can we live without the pancreas?

Yes, humans can live without a pancreas. Even after pancreatic surgery, the body loses digestive enzymes and insulin, which control blood sugar levels. The gastroenterologist will substitute enzyme tablets to aid digestion and insulin to regulate blood sugar levels. In some cases, insulin injections may be considered in conjunction with dietary and lifestyle adjustments, depending on each individual's physical condition.

What is the recovery time for pancreatectomy?

Typically, pancreatectomy takes approximately 4-6 weeks to recover, depending on each individual's post-surgery health, diseases and extent of surgery, and surgical techniques. Afterward, patients can return to work and perform daily activities as usual.

Pancreatectomy at MedPark Hospital

Surgical Clinic, MedPark Hospital, Bangkok, Thailand, is led by a team of expert gastrointestinal and liver specialists with extensive experience both nationally and internationally, who are ready to provide diagnostic investigations, such as ERCP, or endoscopic ultrasound, and therapeutic intervention for challenging and complex biliary tract and pancreatic diseases with pancreatectomy, and laparoscopic distal pancreatectomy, enabling minimal incisions, less pain, and a quick recovery integrated with JCI standard operating rooms, state-of-the-art medical technology, and equipment combined with advanced surgical techniques, which aids in the treatment precision, speed, and safety, ensuring the utmost treatment efficiency while providing follow-up and post-operative evaluation, assuring the patient free of complications, recovers quickly, has a good quality of life with a physically healthy and can perform daily activities as usual.