Pancreatic Resection

(Removal of Pancreatic Tissue)

Why is it necessary to remove part or whole of pancreas?

Malignant process (cancer) or conditions that have a strong tendency to develop malignancy in the future may require removal of pancreas.

What are the main types of operations?

Broadly, there are three main operations:

Pancreatico-duodenectomy; Whipple’s operation
This operation aims to remove the head of the pancreas, duodenum, gallbladder and bile duct. In the second part of the operation, a loop of small bowel is then joined to remnant pancreas, bile duct and stomach. There are no external stomas or bag.

Distal Pancreatectomy with or without splenectomy
This removes the left side of the pancreatic gland, called body and tail of pancreas, but leaves the head of the Pancreas intact. Spleen is an organ intimately involved with the tail of the pancreas and often needs to be removed. This operation can be performed through the key hole or laparoscopic route.

Total Pancreatectomy with or without splenectomy
As the name implies, the whole of the pancreatic gland is removed, along with duodenum (part of early small bowel), part of bile tube, gallbladder and often the spleen, although the spleen may be preserved some times. A total pancreatectomy is performed if there is malignant or pre-malignant process affecting the whole of the pancreas.

What are the consequences of removing pancreatic tissue?

The main function of the pancreas is to produce insulin (prevents diabetes) and to help digest the food by breaking it down with enzymes. Patients are at risk of diabetes and insufficiency of enzymes after pancreatic resections. If the whole of the pancreas is removed patients will be diabetic for life. Patients will need pancreatic enzyme supplementation after most pancreatic operations.

What about recovery from pancreatic operations?

These are big complex operations often requiring several hours to complete. Consequently, the recovery takes time. This is also dependent on whether a Whipple’s or a distal pancreatectomy is performed. The hospital stay with the former is usually around 10 days, and it may take several weeks to regain fitness.

Chemotherapy is often required for the common form of pancreatic cancer. This is associated with an improved chance of cure and prolonged survival.

Whipple's Procedure Distal Pancreatectomy and splenectomy
Royal College of Surgeons American College of Surgeons University of Liverpool Mayo Clinic