Pancreatic resection is a surgical procedure involving removing a part of the pancreas. A pancreatic resection is usually performed to treat a tumour and may include the removal of the body and the tail of the gland. In some cases, the spleen may also be removed.
A few reasons why pancreas resection is recommended are:
Pancreatic Carcinoma :
- Pancreatic endocrine tumours (insulinoma): A rare tumour that begins in the endocrine cells of the pancreas that produce the hormone insulin.
- Pancreatic cysts: These are fluid-filled sacs on or inside the pancreas. These cysts are usually found during imaging tests and can be non-neoplastic or neoplastic. Most pancreatic cysts do not cause symptoms and are not cancerous. However, cancerous pancreatic cysts must be excised surgically.
- Chronic pancreatitis: This is a progressive inflammatory disorder of the pancreas, which leads to irreversible destruction of the endocrine and exocrine parts of the organ. The damaged region is replaced by fibrotic or scar tissue, resulting in symptoms like abdominal pain, malabsorption and diabetes mellitus. Several causes result in chronic pancreatitis, the most common being alcohol abuse, ductal obstruction, genetic conditions like cystic fibrosis, chemotherapy and autoimmune conditions like systemic lupus erythematosus.
- Periampullary carcinoma : Occurring near ampulla of vater i.e Pancreatic duct insertion
Whipples Pancreatic Duodenectomy: - Removal of pancreatic head 2nd part of duodenum and bile duct.
Distal Pancreatectomy: Removal of body and tail of the pancreas (For bosy and tail tumor).
Body location – Carcinoma Duodenum
In the abdomen, behind the stomach and front of the spine.
How is it performed?
On the day of the surgery, you must report to the hospital after a minimum of 10 to 12 hours of fasting. Once in the operation theatre, the anaesthesiologist provides anaesthesia through an IV line in a vein in your arm. This will put you to sleep during the procedure, and you won’t feel or remember anything. During the surgery, your surgeon will place multiple tubes to support your organs.
Most pancreatic but now a day resections were performed using open surgery as it gives full access to all organs in the region. In some cases, laparoscopic or robotic surgery is used to perform the procedure and make recovery quicker and more comfortable. Robotic surgery provides the quickest recovery and most precise surgery.
If your surgeon feels you need surgery for your pancreas, they will recommend several tests before the procedure, which may include:
- Routine imaging tests: Ultrasonography, X-rays, and computed tomography scans (CT scans) are done for many reasons, both before and after a pancreas resection procedure. These tests are helpful in pancreatic cancers to detect suspicious areas that may be cancerous, check how far cancer has spread, monitor if earlier treatments are working, and look for signs of cancer recurrence.
- Endoscopic retrograde cholangiopancreatography (ERCP): An imaging technique that helps visualise ducts that carry bile towards the gallbladder also for stenting if required (Sometimes required).
- Angiography: To visualise arteries supplying blood to the pancreas
- Needle aspiration: To check for cancer cells in the pancreas
- Whole body PET CT to rule out metastasis.
Preparing for your pancreas resection may also involve other steps, such as:
- Chemotherapy (In case of boderline resectable tumor
- Pre-operative medications to reduce the chance of infection after surgery
- Pre-operative bowel preparation.
Discuss any questions you have with your doctor regarding the type of surgical procedure they are likely to use, recovery time, risks, and the kind of anaesthesia used for surgery.
A pancreatic resection is a major surgery, and you may require a long hospital stay. While most people can return home in a week or so, some may need to stay for as long as two or three weeks. If a pancreas resection surgery is performed to remove a tumour, you may also require chemotherapy or a combination of chemotherapy and radiation therapy to improve the survival rate. Chemotherapy or Radiotherapy will start only after full recovery.
After surgery, you will feel pain and discomfort in the abdomen, and your doctor will prescribe appropriate pain medications. You must visit your doctor for a follow-up to monitor your health. If you have undergone complete pancreatic resection, you will require pancreatic enzyme replacement therapy and insulin injections to ensure adequate digestion.
There is a fair amount of risk associated with a pancreas resection procedure. In fact, according to a John Hopkins study, around 41% of pancreas resection cases tend to have some risk.
A few common ones include:
- Postoperative bleeding
- Delayed gastric emptying (food and liquids leave the stomach slowly)
- Pancreatic anastomotic leak
- Pancreatic insufficiency
- Infections at the surgical site
- Urinary tract or chest infections
- Scarring or adhesions
It is important to discuss the potential risks with your doctor before undergoing a pancreas resection procedure. Your doctor will be able to provide more information about the specific risks associated with pancreas resection and help you make an informed decision about your treatment.
Recovery from a pancreas resection takes four to eight weeks, depending upon your health before the procedure. The recovery duration also depends on the type of surgery—open or laparoscopic. You will need to take a few weeks off work to allow your body to rest and heal adequately. It is essential to take small, light walks around the house to promote healthy circulation and enable you to rebuild your body and core strength. Avoid heavy lifting, straining or intensive exercises until complete recovery.