In distal pancreatectomy, the tail and/or a portion of the pancreas are removed. The pancreas head is not affected in pancreatectomy. This surgery is uncommon for pancreatic cancer because most of the tumors arising beyond the head region of the pancreas are unresectable. Distal pancreatectomies are performed less often than resections of the pancreatic head.
It is performed in the following cases:
- Chronic and recurrent inflammation of the pancreas (pancreatitis)
- Pancreatic tumors in the body or tail
- Pancreatic cysts
- Pancreatic trauma
- Spleen-preserving distal pancreatectomy
How is the surgery performed?
The surgery is performed under general anesthesia and takes approximately 2-4 hours.
Staging laparotomy is essential before resection. During a staging laparotomy, the surgeon inserts a scope (a camera with a light source) through a small incision (a surgical cut) in the abdomen.
A staging laparotomy helps to examine the structures in the abdominal cavity and allows the doctor to stage the cancer of the pancreas. The surgery may be performed through an open procedure or minimally invasive procedures such as laparoscopically or by robotic-assisted surgery.
There are also various surgical techniques depending upon the disease, extent of surgery, and surgeon’s expertise.
- Open distal pancreatectomy and splenectomy: In this technique, the spleen is separated and mobilized first, and the resection of the pancreas is performed afterward. The tumor is resected completely preserving the surrounding healthy tissues. Surrounding lymph nodes may be removed.
- Radical antegrade modular pancreatosplenectomy (RAMPS): In this technique, the neck of the pancreas is divided first, and mobilization of the spleen is performed at the ultimate step. The tumor is resected completely preserving surrounding healthy tissues. Surrounding lymph nodes may be removed.
A spleen-preserving distal pancreatectomy may be performed if there is no indication for spleen removal.
- The patient should stop taking blood thinners (aspirin, heparin, warfarin, or clopidogrel)
- They must consult a doctor if they are on any prescription medication, or over-the-counter drugs, herbs, minerals, or natural remedies.
- They must inform the surgeon if they have any implantable device, a problem with the anesthetic procedure, allergy to any drug, sleep apnea, or any other pre-existing clinical conditions.
- They must stop taking alcohol well before surgery. Withdrawal symptoms should be managed by medications.
Surgery, Minimally invasive surgery / Robotic
A regular follow-up per the surgeon’s recommendation is necessary for the following reasons:
- To understand if your pancreas is able to secrete sufficient digestive enzymes. Even though part of the pancreas will be removed, there’s usually enough of the pancreas left after the surgery to synthesize enzymes. If the pancreas doesn’t make enough digestive enzymes, the patient may have diarrhea and need to take enzyme medications.
- To understand if the remnant of the pancreas is making enough insulin after the surgery. In the rarest case, they may have high blood sugar and need a consultation with a diabetologist.
Along with general postoperative complications the major morbidity-associated complications with the procedure are as follows:
- Pancreatic fistula
- Intra-abdominal abscess
- Anastomotic failures
- Pulmonary embolism
- Wound infection
- Renal failure
During the postoperative phase, patients are given pain medications and antibiotics. The patients are discharged from hospitals after 5-7 days post-surgery. Despite the complexity of the procedure, most people recover successfully. Patients must start moving as soon as feasible and keep doing exercise and maintain a proper diet to recover early.