Pancreatectomy

Pancreatectomy

(Central Pancreatectomy; Distal Pancreatectomy; Total Pancreatectomy)

Definition

The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin.
The Pancreas
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This is surgery to remove the pancreas. In this procedure, all or part of the pancreas can be removed. In some cases, other nearby structures may also be removed, such as:
  • Gallbladder
  • Spleen
  • Part of the stomach or small intestine
  • Nearby lymph nodes

Reasons for Procedure

This procedure is done to treat certain health conditions, such as pancreatic cancer or pancreatic necrosis due to pancreatitis .

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Leakage of pancreatic enzymes into the abdomen
  • Damage to other organs in the abdomen
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
  • Poor nutrition
The pancreas produces many necessary digestive enzymes and helps regulate blood sugar. When part of the pancreas is removed, long-term complications may result, such as:

What to Expect

Prior to Procedure

You may need to have chemotherapy or radiation therapy to reduce the size of a tumor before surgery.
Leading up to the procedure, your doctor may do the following:
  • Physical exam
  • Blood tests
  • Imaging studies to better locate the cancer or area of necrosis
Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
You should arrange for a ride to and from the hospital and have someone stay with you the first night.

Anesthesia

General anesthesia will be used. You will be asleep through the surgery.

Description of the Procedure

An incision will be made in the abdomen. The affected part of the pancreas, as well as other affected areas, will be removed. The incision will be closed with stitches or staples.
Tubes may be placed that come out of the abdomen. A tube will drain fluid from the surgery site. Another tube may run from the intestines and out of the abdomen to give you nutrition.
If only a part of the pancreas needs to be removed, your doctor may do the surgery laparoscopically. Small incisions will be made and a camera will be inserted. This will help the doctor see inside the abdomen to remove the affected part of the pancreas.

How Long Will It Take?

The surgery can take 4-8 hours, depending on what part or how much of the pancreas is removed.

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay

You may need to stay in the hospital from 5 days to 3 weeks. This depends on the extent of your surgery. If you have any problems, you will need to stay longer.

Post-procedure Care

At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
  • Pain medications
  • Antibiotics to prevent infection
  • Medication to prevent blood clots
You will be encouraged to be mobile as soon as possible. This start as soon as the first day after your surgery.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
When you return home, take these steps:
  • Depending on how much of your pancreas was taken, it may not make adequate amounts of enzymes for your body. If this is the case, your doctor may recommend a special diet, supplements, or other medications.
  • Be sure to follow your doctor's instructions.

Call Your Doctor

Call your doctor if any of these occur:
  • Signs of infection, such as fever or chills
  • Redness, swelling, increasing pain, bleeding, or discharge from the incision
  • Pain that you can't control with the medications you've been given
  • Persistent nausea or vomiting
  • New or worsening diarrhea—this may indicate you are not digesting enzymes properly
If you have symptoms of diabetes, call your doctor. You may need to have your insulin dose adjusted. Symptoms include:
  • Extreme thirst
  • Frequent urination
  • Difficulty controlling urination
  • Increased urination at night
  • Extreme hunger
  • New or worsening fatigue
  • Blurred vision
  • Numbness or tingling in hands or feet
  • Sores that heal slowly, especially in the legs or feet
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

National Cancer Institute http://www.cancer.gov

Pancreatic Cancer Action Network http://www.pancan.org

CANADIAN RESOURCES

Canadian Cancer Society http://www.cancer.ca

Pancreatic Cancer Canada http://www.pancreaticcancercanada.ca

References

Allendorf J. Surgical options. The Pancreas Center. Columbia University Medical Center website. Available at: http://www.columbiasurgery.org/media/lectures/pancreas%5Fawareness%5F20101113.pdf. Published November 13, 2010. Accessed December 9, 2014.

Pancreatic cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf. Updated June 11, 2014. Accessed December 9, 2014.

Learn about pancreatic cancer: surgery. Pancreatic Cancer Action Network website. Available at: http://www.pancan.org/section%5Ffacing%5Fpancreatic%5Fcancer/learn%5Fabout%5Fpan%5Fcancer/treatment/surgery. Accessed December 9, 2014.

Pancreatic cancer. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated December 4, 2014. Accessed December 9, 2014.

Surgical techniques for pancreas preservation. Center for Pancreatic and Biliary Diseases, University of Southern California website. Available at: http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas%20resection/ORGAN%20PRESERVATION.html. Accessed December 9, 2014.

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