Pancreatectomy

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Pancreatectomy is a procedure that may be used to treat a number of health issues related to the pancreas, including pancreatic cancer and tumors that have the potential to become cancerous, called intraductal papillary mucinous neoplasms (IPMNs).

For people with pancreatic cancer, this surgery is performed to remove the cancer, if possible, or for symptom relief or prevention of complications, even when all of the cancer cannot be removed.

A pancreatectomy may also be used to treat:

• Tumors formed from pancreatic cells that release hormones (called neuroendocrine tumors), which may also be cancerous (malignant) or noncancerous (benign)
• Benign lesions on the pancreas
• Pain from pancreatitis (inflammation of the pancreas)
• Trauma to the pancreas
• Pancreatic pseudocysts, or fluid-filled sacs
• Duct issues in the pancreas, such as narrowing (stricture)
• Complications from previous pancreatic surgery, such as fistulas (abnormal openings between body structures that allow for fluid leaks)

What Is a Pancreatectomy?

The pancreas is an organ that sits behind the stomach in the abdominal cavity that produces digestive enzymes, insulin and other hormones. When surgeons remove all or part of the pancreas during surgery, it is known as a pancreatectomy.

Doctors may recommend a pancreatectomy for patients diagnosed with pancreatic cancer if testing reveals that the tumor is resectable, meaning there is a high likelihood that the surgeon will be able to remove all of the cancer.

There are three main ways a pancreatectomy is performed as a pancreatic cancer treatment.

Open pancreatectomy: The surgeon cuts the middle of the abdomen (belly) to access the pancreas.

Laparoscopic pancreatectomy: Smaller cuts are made in the abdomen and surgical tools are inserted into these openings, including a flexible instrument with an attached camera for viewing the pancreas called a laparoscope.

Since these cuts are smaller than open surgery cuts, this is sometimes called minimally invasive surgery.

Robot-assisted pancreatectomy: This is laparoscopic surgery that uses a robotic device with surgical tools attached controlled by the surgeon. This technique may be especially beneficial for making more precise, smaller surgical incisions (cuts).

Since the pancreas includes five sections, the doctor may perform different types of pancreatectomy procedures, depending on the location and stage of the cancer.

During a partial pancreatectomy, the surgeon removes one or more sections of the pancreas, while during a total pancreatectomy, the entire pancreas is removed. Nearby structures and organs may also be removed during these surgeries.

Distal Pancreatectomy

If cancer tumors are only found in the tail and part of the body of the pancreas, a distal pancreatectomy may be performed to remove those sections. This procedure is sometimes called a left partial pancreatectomy. Since the spleen’s artery is located along the body of the pancreas, this organ is sometimes removed as well in a procedure known as a distal pancreatectomy with splenectomy.

A distal pancreatectomy takes about two to five hours to perform.

Central Pancreatectomy

A central pancreatectomy is used to treat noncancerous or low-grade (slow-growing and spreading) cancer lesions found in the center (proximal) body of the pancreas, and sometimes in its neck. It typically takes about three to five hours for surgeons to complete this surgery.

This type of surgery is usually only performed to remove borderline (potentially cancerous) pancreatic lesions that have not spread at all, and it helps maximize how much functioning pancreas remains.

Pancreaticoduodenectomy

A pancreaticoduodenectomy, or Whipple procedure, is the type of surgery recommended for nearly all resectable (removable) cancers in the pancreas head, and it is quite complex.

During the operation, the head of the pancreas and nearby lymph nodes are removed. Depending on how far the tumors have spread, the body of the pancreas may also be taken out. Because the pancreas is so close to other organs and structures in the abdominal cavity, the surgeon also removes the duodenum (beginning part of the small intestine), bile duct, gallbladder and, at times, a portion of the patient’s stomach to help ensure that all cancer has been extracted.

Next, the remaining pancreas and bile duct sections are connected to the small intestine to allow the pancreatic digestive enzymes to flow into it. The surgeon’s final step during the reconstruction is to attach any detached pieces of the small intestine, or the small intestine and stomach, to each other.

The time it takes to complete a Whipple procedure ranges from about four to nine hours.

Total Pancreatectomy

Surgery to remove the whole pancreas, spleen and common bile duct is known as a total pancreatectomy. During this operation, a portion of the stomach and small intestine are also removed, and any stomach and bile duct that remain are connected to the remaining small intestine.

Although it is rarely performed, total pancreatectomy is the surgery of choice if tests reveal that cancer has spread throughout the entire pancreas.

Because it is a fairly extensive surgery, a total pancreatectomy may take between 4.5 to seven hours to complete.

Pancreatectomy Recovery

Most patients do well immediately after pancreatectomy surgery, but the overall time spent in the hospital varies for each patient, based on personal risk factors and whether any complications emerge after surgery.

During the hospital stay, the staff provides intravenous fluids until the patient is able to drink without assistance, as well pain medication to help prevent discomfort in the abdominal region, if needed. Tubes are also placed into the abdomen to help drain any blood or fluids after the surgery.

Patients may expect to stay in the hospital:

• About five to nine days after a distal pancreatectomy
• About nine to 15 days after a central pancreatectomy
• About six to 12 days after a Whipple procedure
• About five to seven days after a total pancreatectomy

Full recovery time after pancreatectomy surgery is different for each patient. It may vary from several weeks to several months, depending on whether there were any complications, the patient’s overall health and response to treatments. For each type of surgery, healing times may be faster with minimally invasive surgery, such as laparoscopic and robot-assisted surgery, than with open surgery.

While every patient is different, some procedures may allow for more optimal recovery outcomes. For example, those who undergo a central pancreatectomy may have better long-term pancreas functioning (insulin and digestive enzyme production) than those who have a Whipple procedure or a distal pancreatectomy.

The patient’s doctor meets with him or her after release from the hospital to address any new or ongoing issues related to healing from a pancreatectomy and provide the appropriate follow-up treatments.

Since there is a risk of cancer returning after a pancreatectomy, additional treatments such as chemotherapy or radiation therapy to help improve the patient’s long-term recovery outlook may also be recommended.

Can People Live Without a Pancreas?

People are able to live without a pancreas, but it may cause complications. If a portion of the pancreas is removed, the remaining sections may still be able to make the cells that produce insulin to regulate blood sugar and digestive enzymes to help break down fats, carbohydrates and proteins.

However, people who undergo a total pancreatectomy will develop diabetes because they no longer produce insulin. They will need to take insulin shots for the rest of their lives, as well as pancreatic enzyme pills to ensure that the small intestine has the chemical substances it needs to digest food. Some people who undergo partial pancreatectomies may also produce limited amounts of insulin and require insulin shots.

Pancreatectomy Side Effects

The side effects of pancreatectomy surgery may include:

• Bleeding
• Blood clots in the lungs or legs
• Infections
• Allergic reactions to anesthesia (sleeping medication given during surgery)
• Difficulty emptying the stomach
• Breathing issues
• Heart problems
• Weight loss
• Diabetes
• Leaking of pancreatic, small intestine, bile duct or stomach fluids due to fistulas, which may need to be fixed with follow-up surgery

Patients who undergo complex pancreas surgery like a Whipple procedure at a cancer center with surgeons experienced in performing the procedure are significantly less likely to experience life-threatening complications than those who have the procedure done at a smaller hospital or by less experienced surgeons.

City of Hope^® has one of the nation’s most experienced pancreatic cancer surgery teams and has performed thousands of surgeries on the pancreas and nearby structures. Our surgeons are at the forefront of developing minimally invasive procedures to reduce complications and elevate pancreatic surgery outcomes.