Diagnoses of pancreatic cancer or conditions such as cysts that lead to cancer may require an operation on the pancreas.
The type of pancreatic surgery needed depends on the location of the cancer or cyst. These operations are complex and are usually performed by surgeons who specialize in pancreatic surgery.
For lesions located in the body or tail of the pancreas, most often a distal or left partial pancreatectomy is recommended. The technique for a distal pancreatectomy can vary and includes removing part of the pancreas with or without the spleen. The reason the spleen often needs to be removed for this operation is because the artery to the spleen is located along the course of the body and tail of the pancreas. Removing the tail end of the pancreas is known as a distal pancreatectomy.
For lesions located in the region of the head of the pancreas, a pancreaticoduodenectomy (Whipple procedure) is typically performed. This operation entails removal of the head of the pancreas. Because the head of the gland is located so close to other structures, these need to be removed along with the head of the pancreas. These structures include the duodenum (first part of the small intestine), bile duct, gallbladder, and sometimes part of the stomach. Once removed, a reconstruction of these structures needs to be performed reconnecting the pancreas, stomach, bile duct, and intestine.
In rare cases in which patients have many tumors or multiple high-risk cysts, removal of the entire pancreas is required (total pancreatectomy). Because the pancreas is where metabolic hormones such as insulin are made, complete removal of the pancreas results in diabetes. In addition, removal of the pancreas requires oral supplements of pancreatic enzymes to aid in digestion.
Although pancreatic surgery is complex, most patients do well after surgery. Recovery in the hospital depends on whether any complications or delay in gastrointestinal function occur after the operation. Patients without any complications typically are discharged from the hospital 6 to 7 days after a Whipple procedure and 4 to 5 days after distal pancreatectomy. Among the complications that can occur, leakage of the pancreatic reconstruction or delay in stomach emptying are the most common. These problems are usually self-limited but may delay the period of recovery.
Patients can have long-term excellent quality of life after pancreatic surgery and return to normal life. Among patients undergoing pancreatectomy for cancer, risk of cancer recurrence can be high, particularly with adenocarcinoma. These patients are often offered chemotherapy, either before or after surgery, and sometimes radiation therapy. For patients undergoing pancreatectomy for conditions such as cysts, no additional therapy is required. However, the potential risk of new cysts or cancers forming in the remaining pancreas often warrants lifetime follow-up.
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Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Source: Stark A, Donahue TR, Reber HA, Hines OJ. Pancreatic cyst disease: a review. JAMA. 2016;315(17):1882-1893.
Nassour I, Choti MA. Pancreatic Operations. JAMA. 2016;316(18):1932. doi:10.1001/jama.2016.11165