Pancreatectomy

What is a pancreatectomy?

A pancreatectomy is surgery that removes part or all of your pancreas. Your pancreas is part of your digestive system. It has two main functions. It makes enzymes that help break down food for digestion, and it makes hormones that help maintain your blood sugar levels and store energy from food.

Why would you need a pancreatectomy?

Tumors and pancreatitis are the two most common reasons why healthcare providers recommend a pancreatectomy.

Tumors are at risk of spreading to other parts of your body, and removing them from your pancreas helps reduce that risk. Pancreatitis happens when your pancreas becomes inflamed. It can lead to severe pain and other complications, which can be an indication for a pancreatectomy.

What is pancreatectomy surgery done for?

Conditions that may be treated with pancreatectomy include:

• Pancreatic cancer.
• Pancreatic neuroendocrine tumors, such as insulinoma.
• Metastatic kidney cancer.
• Pancreatic cysts.
• Severe chronic pancreatitis.

What are the different types of pancreatectomy surgery?

Your pancreas is shaped a bit like a fish, with a wide “head,” a moderate “body” and a narrower “tail.” Different procedures may remove the head, tail, middle or all of the pancreas. Sometimes, other nearby organs and vessels also need to be removed.

• Distal pancreatectomy. The distal part of your pancreas is the body and tail (“distal” means distant, or the farthest part from the center). A distal pancreatectomy removes the tail of your pancreas, and sometimes the body if that’s involved, too. The tail of your pancreas is closely connected to your spleen. A distal pancreatectomy often involves removing your spleen along with the tail of your pancreas.
• Central pancreatectomy. A central pancreatectomy removes the central body of your pancreas, leaving the head and tail intact. This difficult operation is rarely indicated. It’s only practical if you’re removing something locally. But, when possible, it can help preserve more of your pancreatic function and prevents the need for additional organ removal.
• Pancreaticduodenectomy (Whipple procedure). A pancreaticduodenectomy removes the head of your pancreas, along with the part of your small intestine that connects to it (your duodenum). Because the common bile duct also runs through the head of your pancreas and drains into your duodenum, your bile duct and gallbladder are also removed. The Whipple procedure concludes by reattaching your remaining pancreas, bile duct and stomach to your remaining small intestine so that digestion can continue normally.
• Total pancreatectomy. A total pancreatectomy removes your entire pancreas when the whole organ is affected by disease, or when there isn’t enough healthy tissue left to preserve. Removing your whole pancreas also involves removing several other organs, vessels and lymph nodes surrounding it. Typically, that includes your spleen, gallbladder, duodenum and the lower part of your stomach. The operation then reconnects your stomach and bile duct to your small intestine.

Can you live without a pancreas?

Yes, you can, but not without side effects. Without the enzymes and hormones that your pancreas once produced, you’ll have difficulties regulating your blood sugar and absorbing nutrients from your food. You’ll need supplemental therapies to replace them.

Will I have diabetes after my pancreatectomy?

You might. As your pancreas is where your natural insulin comes from, removing much of it could make you dependent on insulin therapy. However, a partial pancreatectomy does leave some insulin-secreting cells behind, and sometimes they’re enough.

If you’re having a total pancreatectomy, you’ll have diabetes afterward unless your surgeon can preserve some of your insulin-producing cells. This depends on your condition. Sometimes, your surgeon can transplant some of these cells into your liver.

What happens before a pancreatectomy?

You may have to take several steps to prepare for surgery in the days ahead. These might include:

Testing: You’ll meet with a nurse practitioner for presurgical testing. They’ll review your medical history and current medications with you. You may have some standard medical tests to make sure you’re in good health for the surgery, such as a chest X-ray or EKG.

Quitting: Your nurse will also ask about your current alcohol use. It’s important to be honest about this. Alcohol use can cause certain complications during and after the surgery. Your healthcare team can help you stop safely and treat your withdrawal symptoms as necessary.

Medications:You may be given an antiseptic skin cleanser to clean with before the procedure. This will help prevent bacterial infections after surgery. You may need to stop taking certain medications, such as NSAIDs and blood thinners, some days before.

What happens during the pancreatectomy procedure?

When it’s time for surgery, your healthcare team will help you onto the operating bed and your anesthesiologist will deliver anesthesia through an IV line in your arm. This will put you to sleep for the procedure. Your IV will continue to deliver fluids and medicine, and sometimes nutrition.

Your healthcare team will place various tubes to support your body while you’re under anesthesia. You’ll have a tube in your windpipe to help you breathe and one in your stomach to prevent nausea. You’ll have a Foley catheter to drain your pee and tubes in your abdominal cavity to drain excess fluids.

Most pancreatectomies are performed through open surgery, which offers ready access to many organs at once. Some medical centers may be able to perform certain pancreatectomies through minimally invasive methods, such as laparoscopic or robotic surgery. These methods make recovery a little easier.

If you’re having open surgery, your surgeon will make one long incision across your abdomen to open your abdominal cavity. If you’re having laparoscopic or robotic surgery, your surgeon will make several small “keyhole” incisions. They’ll operate through these, using long tools and a camera (laparoscope).

How long does a pancreatectomy operation take?

A central or distal pancreatectomy takes about four hours. A total pancreatectomy or Whipple’s procedure takes about six hours.

What happens after a pancreatectomy?

You’ll be moved to a hospital room where your healthcare team will closely monitor your health and vital signs. You’ll have some of your tubes in place still that’ll likely be removed in the coming days. You’ll be in the hospital for about a week, sometimes a little more.

During your stay, you’ll gradually wean from your on-demand pain medication. You’ll be helped out of bed starting on the first day after surgery and begin moving around a little more each day. You’ll gradually transition from a liquid diet to more solid foods. You may be constipated at first. Your nurse can help with this.

Your healthcare team will also be monitoring your digestion and blood glucose levels after your pancreatectomy. They’ll need to know how you’re doing with your reduced pancreatic function. They’ll adjust your diet and prescription medications accordingly.

What is the advantage of having a pancreatectomy?

Healthcare providers only recommend a pancreatectomy when it’s medically necessary. That usually means that you have cancer in your pancreas and that surgery could help you live longer. Sometimes, another disease is causing persistent problems, and surgery is the only solution.

What are the possible risks or complications of the procedure?

Complications that may occur during surgery include:

• Bleeding.
• Infection.
• Blood clots.
• Anastomotic leak.

After the procedure, short-term side effects may include:

• Paralytic ileus. Your bowels may not want to move for a few days following surgery. This is normal. You’ll stay on a liquid diet until they’re ready to move again.
• Delayed gastric emptying. Sometimes, your stomach may also be slow to release food into your intestines. This may require medications called prokinetics.
• Dumping syndrome. If your total pancreatectomy or Whipple’s procedure involves removing and/or reconstructing the lower part of your stomach (pyloroplasty), you may have a side effect called dumping syndrome. This means that your altered pylorus doesn’t moderate the passage of food from your stomach into your small intestine very well anymore. Instead, the food all dumps in at once (rapid gastric emptying). This can cause a variety of gastrointestinal symptoms after you eat. It’s usually temporary and can usually be managed with dietary changes.
• Weight loss. Weight loss of 10 pounds to 15 pounds is typical after a pancreatectomy for several reasons, including dietary changes and changes in the way your digestive system functions. As you and your healthcare provider navigate these changes, your weight should soon stabilize.
• Fatigue. Pancreas surgery can cause you to be more tired than usual. You’ll have days where you feel great and are up walking around, and then the next day you may feel tired and want to take naps. This is normal. It’s like your body is running a marathon, except instead of using that energy to run and move muscles, your body is using that energy to heal you on the inside — and you have a lot to heal on the inside after a pancreatectomy.

You’ll have long-term complications after a total pancreatectomy or after any pancreatectomy that removes enough of your pancreas to impact its functionality. You may also have complications from the loss of other organs that need to be removed during your pancreatectomy. Some of these include:

• Diabetes. A partial pancreatectomy can bring the onset of diabetes if too many insulin-producing cells are removed. This occurs in 10% of cases. A total pancreatectomy will bring diabetes in all cases, except when your surgeon is able to successfully transplant the islet cells. Your healthcare provider will prescribe insulin therapy on a sliding scale according to your need.
• Exocrine pancreatic insufficiency. If your pancreas can’t produce enough pancreatic enzymes, you’ll have side effects of indigestion and malabsorption. This can cause discomfort and diarrhea on one end of the spectrum and malnutrition on the other end. Your healthcare provider will prescribe pancreatic enzyme replacement therapy (PERT) according to your need.
• Compromised immunity. If your total or distal pancreatectomy involves removing your spleen, this will impact your immunity to certain infectious diseases. Your spleen is part of your immune system, responsible for making antibodies that help fight infections. When you have your spleen removed, your healthcare provider may recommend certain vaccines to help prevent infections.
• Non-alcoholic fatty liver disease. Changes to your metabolism following a pancreatectomy can result in excessive fat storage in your liver (steatosis). This doesn’t always cause problems, but in some cases, it can lead to chronic inflammation in your liver (steatohepatitis) and progressive liver disease.

How long does it take to recover from a pancreatectomy?

Recovery at home may take four to eight weeks, depending on your baseline health going into the operation, as well as the extent of the operation and whether you had minimally invasive or open surgery.

When should I call my healthcare provider after my pancreatectomy?

Call your healthcare provider if you have:

• Any signs of infection at the incision site, such as swelling, redness or discharge.
• A fever of over 100 degrees Fahrenheit (37.77 degrees Celsius).
• Persistent diarrhea or constipation.
• Any new or worsening pain.

A note from Cleveland Clinic

A pancreatectomy is a serious operation that can have lifelong consequences for your digestive system. But if your healthcare provider has recommended a pancreatectomy, it’s because they believe the benefit to you is worth it. Whether you have a life-threatening condition or one that severely diminishes your quality of life, a pancreatectomy could cure it. Your healthcare provider will walk you through the pros and cons of your condition and help prepare you for the best outcome.