Pancreatectomy

ALSO KNOWN AS: Pancreatoduodenectomy, Whipple procedure, distal pancreatectomy, total pancreatectomy

DEFINITION: Pancreatectomy is a surgical procedure to remove all or part of the pancreas.

Cancers treated:Pancreatic cancer

Why performed: Pancreatectomy is done to remove all or part of the pancreas. This procedure may be performed when trying to cure the cancer by removing all of it, or it can be done as palliative care to reduce or prevent symptoms from cancer that has already spread to other areas.

Patient preparation: The first step of patient preparation is a thorough evaluation by the cancer care team to ensure the patient is a good candidate for a pancreatectomy. It is a very difficult procedure that usually has a long recovery time, and it is not appropriate for many individuals. The procedure is appropriate only for individuals who have cancer that is expected to be fully removable by the procedure. Approximately 20 percent of individuals diagnosed with pancreatic cancer are good candidates for this surgery. In some cases, pancreatectomy may also be appropriate as a palliative treatment.

Some patients receive radiation or chemotherapy before pancreatectomy. This may be done to shrink the tumor and make complete removal more likely. It may also be done before the procedure because the high risk of complications and long recovery time often mean that necessary additional treatments cannot begin until many weeks after the surgery. In the days before the procedure, patient preparation is generally similar to that for other major surgical operations. Patients may be instructed to avoid food or liquids for a certain amount of time before the procedure, or they may be given antibiotics or other medications to help minimize the risk of complications.

Steps of the procedure: Three main types of pancreatectomies are performed. Which one is performed depends on where the cancer is located and the extent of the cancer’s spread. If the goal is palliative, the procedure performed will depend on the symptoms being treated or prevented. The three types of procedures differ in the amount and section of the pancreas that is removed.

The most common type of procedure is a pancreatoduodenectomy, also called the Whipple procedure. During this procedure, the surgeon removes the head of the pancreas (the part closest to the small intestine), the duodenum, the gallbladder, and part of the bile duct. In some cases, the surgeon removes part of the stomach as well. The part of the pancreas that remains is then surgically connected to the patient’s small intestine.

Another procedure in which only part of the pancreas is removed is a distal pancreatectomy. In this procedure, the surgeon removes only the tail end (the thinner end) of the pancreas. In some cases, the spleen is also surgically removed at the same time. This procedure is appropriate only when the tumor is relatively small and localized in the distal end of the pancreas. Advances in minimally invasive procedures for distal pancreatectomy have made this option increasingly popular.

When the entire pancreas is removed, the procedure is known as a total pancreatectomy. When this is done, the surgeon takes out all the pancreas and usually the spleen. This procedure is used when the cancer is located within the body of the pancreas. This procedure has a high mortality rate and a high rate of complications. However, advances in insulin delivery systems and digestive enzymes have increased positive outcomes for patients undergoing total pancreatectomy.

Doctors may also perform a central pancreatectomy, where the central part of the pancreas is removed, leaving the head and tail intact. Because of the difficulty of this procedure, it is performed rarely and only when cancer is localized. Robotic surgical techniques, such as the da Vinci SP system, have been introduced in all types of pancreatectomies. Technology incorporating artificial intelligence has made selecting the appropriate form of pancreatectomy and improving its outcomes more accurate and efficient.

After the procedure: Pancreatectomy is a major surgical procedure and usually requires a prolonged hospital stay. Most patients remain in the hospital for two or more weeks after the procedure. During this time, the patient is carefully monitored for complications such as infection and bleeding. If the surgery was done using an open technique, then the wound requires care and monitoring. Patients who did not receive chemotherapy or radiation therapy before the pancreatectomy generally receive it as soon as it is feasible after the surgery. If the entire pancreas, or a very large portion of the pancreas, was removed, then the patient may be given a regimen of medications to take to correct insulin and other imbalances if the pancreas no longer produces sufficient quantities for good health.

Risks: There are many significant risks associated with pancreatectomy. According to the American Cancer Society, when a pancreatoduodenectomy is performed by an extremely skilled and experienced surgeon at a hospital or center where the healthcare team is very experienced in the procedure, 0.9 to 3 percent of patients die as a direct result of complications of the surgery. When the procedure is performed by a less experienced surgeon at a small hospital that may not be prepared for possible complications, more patients may die. Nonfatal complications from the procedure are very common. They can include infection, bleeding, and leakage at one of the points a surgical connection was made.

Results: The results from pancreatectomy vary depending on the type of procedure performed and the extent to which the cancer has spread to other areas of the body. For patients who had cancer that is considered completely removable through the pancreatectomy, the five-year rate of survival is about 20 percent.

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