Introduction

The pancreas is an oblong-shaped organ in the upper abdomen, sitting between two organs, part of the small intestine on its right and the spleen on its left. Structurally, on a macroscopic scale, the pancreas can be divided into four regions, a head, neck, body, and tail. Microscopically, the pancreas is composed of a variety of cells. Through the organ secreting an array of enzymes and hormones from its various cells, several functions are performed by the pancreas, with the organ playing a particularly critical role in digestion and controlling the levels of sugar in the blood.¹ 

Therefore, when the pancreas is impacted by disease, important bodily functions can become impaired. As a result, when other treatments can not resolve pancreatic disorders, the pancreas may need to be removed, which is done through a procedure called a pancreatectomy. During a pancreatectomy, part or all of the pancreas is surgically removed, using techniques that can vary depending on the case, with the procedure sometimes being minimally invasive or requiring a larger part of the abdomen to be revealed.^{1, 2}

Indications for a pancreatectomy

There are many reasons as to why a pancreatectomy might be recommended for a patient, among these are pancreatic cancer, chronic pancreatitis, and trauma to the pancreas.¹

Pancreatic cancer

Pancreatic cancer impacts nearly five out of 100,000 people. The condition can arise from various pancreatic cells but mostly arises from cells of the pancreatic duct. There are a variety of causes and risk factors for pancreatic cancer, including smoking, being older than 55 years of age, being assigned male at birth, diabetes mellitus, obesity, and certain genes. Pancreatic cancer can cause numerous signs and symptoms, including jaundice, dark urine, weight loss, abdominal pain, weakness, and swelling of the abdomen. The only possible cure for pancreatic cancer is surgical removal of part or all of the pancreas. However, at the time of pancreatic cancer being diagnosed, four out of five cases have progressed too far to be cured.^{3, 4}

Chronic pancreatitis

Chronic pancreatitis is characterised by pancreatic inflammation and a loss of pancreatic cells and tissue. The cause of the disorder is not always known but could involve alcohol, high levels of lipids in the body, and certain genes. Chronic pancreatitis can cause persistent abdominal pain. The condition also can cause the pancreas to not function properly and can lead to malnutrition. Diabetes mellitus is a potential complication of chronic pancreatitis. A pancreatectomy is not always necessary in treating chronic pancreatitis, with other treatments being the replacement of the enzymes that the pancreas produces and dietary changes.⁵

Trauma to the pancreas

Pancreatic trauma can result when the abdomen incurs an injury. Of all abdominal injuries, approximately four per cent involve trauma to the pancreas, which is commonly accompanied by trauma to other organs in the region, such as the spleen. Those who experience pancreatic trauma typically require close monitoring to ensure they are in a stable condition, to determine how serious the injury is, and to assess for and manage any complications, like sepsis. A pancreatectomy is typically reserved for cases where pancreatic trauma is more severe, and the procedure may be accompanied by a splenectomy, which is a surgery to remove the spleen when the spleen incurs trauma too.⁶

Preparation for a pancreatectomy

Medical history 

A medical history is a crucial component of preparing for a pancreatectomy. This involves a physician asking you various questions about past diseases you have been diagnosed with, medications you have taken, procedures you have undergone, as well as questions regarding your social habits and family. The purpose of the medical history is to help a surgeon understand which surgical technique will be best suited to you, to determine whether you are at more of a risk of experiencing certain post-surgical complications, and to establish whether you will need to undergo any specific therapies before a pancreatectomy.^1,7

Blood tests

A series of blood tests will likely need to be taken before a pancreatectomy. This helps a physician determine how physically stable, and nourished, a patient is and whether they will be suitable for surgery. Blood tests determine the quantities of many different substances in the blood, such as cells, minerals, and vitamins. For patients with pancreatic cancer, an important and specific parameter that is measured in these blood tests is cancer antigen 19-9 which is a protein that is found in all people but is particularly elevated in those with pancreatic cancer. Exceedingly high levels of cancer antigen 19-9 may indicate that pancreatic cancer has spread beyond the pancreas and that a patient with the condition may, therefore, not be a suitable candidate for a pancreatectomy.¹

Imaging techniques

Imaging techniques are critical for a surgeon in planning how they will conduct a pancreatectomy. They allow for the pancreas to be visualised, as well as any structural abnormalities, such as cancers. Structurally, the pancreas may vary from patient to patient, so imaging techniques can be useful in determining whether a patient has an anatomical variation of the pancreas, and thus help the surgeon plan a pancreatectomy to specifically suit the needs of said patient. Imaging techniques used can vary but could involve computed tomography, ultrasonography, magnetic resonance imaging, or positron emission tomography.^1,8

Recovery following a pancreatectomy

Hospital-based care

Having a pancreatectomy typically means that you will need to stay in the hospital for some time following the procedure. This stay is often shorter for those who undergo minimally invasive surgery, and longer for those who have a pancreatectomy where a larger part of the abdomen needs to be revealed. The stay in the hospital following a pancreatectomy usually ranges from four to seven days. During this time, a team of medical specialists will monitor you for any complications, and help you achieve a stable enough state to be fit enough to leave the hospital. A team of medical specialists will also develop an at-home care plan for you and coordinate future visits to the hospital.^{1, 9}

Medications

Medications that may be required following a pancreatectomy will vary from patient to patient, depending on the specific condition that leads them to have a pancreatectomy. Furthermore, medications may be needed to treat complications after the procedure, such as diabetes mellitus.¹⁰

Patients can experience some pain after a pancreatectomy as the anaesthesia used in the procedure wears off. Medication can be used to help manage said pain. The medication used differs depending on the level of pain that you are experiencing, though, it could include ibuprofen and opioids.^{10, 11}

Dietary changes

After a pancreatectomy, it is advised that patients abstain from fat as much as possible in their diet, as patients lacking a pancreas often have difficulty tolerating fat; however, this is not the case for all patients. It is important that patients still incorporate essential minerals and vitamins into their diet. A medical professional can help you establish a diet plan suitable for you. Keeping a food diary is also beneficial following a pancreatectomy, as it allows you to keep track of whether you are eating your required nutrients, and keep track of what foods are not well-tolerated.¹⁰

Complications of a pancreatectomy

A pancreatectomy can be a disease-curing and life-saving procedure but also poses the risk of several complications occurring:^{1, 10}

• Fistulas
• Anastomotic leak
• Delayed emptying of the stomach
• Diabetes mellitus
• Death

FAQs

What are the different types of a pancreatectomy?

A pancreatectomy can involve part of, or all of the pancreas, being removed. The procedure can also be minimally invasive or involve a larger part of the abdomen being revealed.¹

How long is recovery time following a pancreatectomy?

Recovery time for a pancreatectomy can vary from patient to patient. Patients will typically remain in the hospital following the procedure for four to seven days.⁹

Does having a pancreatectomy impact life expectancy?

Of patients who undergo a pancreatectomy, about 80 per cent are alive after one year, 72 per cent are alive after two years, and 65 per cent are alive after three years.¹²

Summary

A pancreatectomy is a surgical procedure where the pancreas, partially or in totality, is removed, with this sometimes being minimally invasive or requiring a larger part of the abdomen to be revealed. There are numerous conditions impacting the pancreas that may lead to a pancreatectomy being needed, such as pancreatic cancer, chronic pancreatitis, and trauma to the pancreas. A pancreatectomy requires preparation which may involve a medical history, blood tests, and imaging techniques. Recovery following pancreatectomy can involve hospital-based care, medication, and dietary changes. Though a pancreatectomy can be a disease-curing and life-saving procedure, there is also a risk of certain complications, including fistulas, anastomotic leak, delayed emptying of the stomach, diabetes mellitus, and death.