Pancreas Surgery

How is the pancreas resected?

There are two main operations depending on where the tumour is;

Distal Pancreatectomy
This method means removing the left most portion of the pancreas near the spleen and away from the duodenum. It is usually a straightforward operation technically. It is sometimes possible to preserve the spleen, but often times not. Most patients recover quickly from this surgery and are discharged after a week or so in hospital.

Pancreatico-duodenectomy (Whipple’s Procedure)
This is the most common operation on the pancreas, since most curable pancreas cancers arise in the head of the pancreas near the duodenum and the bile duct. It is a more complicated operation involving removal of the duodenum, the head of the pancreas, the lower bile duct, and part of the stomach. Following the resection, the bile duct, stomach and pancreatic duct all need to be restored into the bowel. The remnant pancreatic duct is sewn into the intestine. The bowel is brought up and joined to the bile duct and then the stomach. Drains are placed near the pancreas and the bile joins to check for leakage. After the surgery there is a tube in the nose that stays for around 4 days, the drains stay in place for 5 to 7 days.

post operative care

Post operative care is different for each person and differs between distal pancreatectomy and the Whipple's procedure. Most patients are admitted to the High Dependency Unit for the first post operative night. After the Whipple's procedure patients are nil by mouth for a 3 to 4 days at least, most having distal pancreatectomy will eat within two or three days. Patients can expect be away from work for 6 to 10 weeks.

What are the potential complications?

The risks of different complications varies between patients. The risks are higher if the patient is older or has significant other illnesses. Most patients have a fairly straightforward course, but some will have serious complications. Only complications of Whipple’s procedure are discussed below, as this is the larger of the operations.

Potential complications of Whipple’s Procedure include (but are not limited to);

Pancreatic leak
If the pancreatic join leaks then very toxic pancreas juice will be free in the abdomen. This can be life threatening, although usually the juice is harmlessly taken away by the drain. It occasionally requires further interventions or even further surgery. It can mean a long time in hospital until the leak heals.

Bile leak
Leakage from the bile join is less common, and less severe than pancreas leak, but may require persistence of the drain for days or weeks.

Gastroparesis
This is ‘lazy stomach’ where the stomach may not pass food on to the gut for sometimes weeks after a Whipple’s procedure. This can be a very frustrating complication and around 10% will suffer it.

Intra-abdominal collection
Fluid may accumulate in the abdomen that can become infected and occasionally needs to be drained.

Bleeding
Some patients will bleed during the surgery enough to require a transfusion, but it is unusual to see post operative bleeding.

Respiratory problems
Most patients have some initial shortness of breath because of wound pain. Gentle chest physiotherapy is helpful.

Diabetes
A small number of patients develop diabetes following pancreas resection.

Other potential complications may include wound infection, clots, allergic reactions or heart troubles.

FAQs

Will I need chemotherapy afterwards?
That will determined by a medical oncologist (cancer specialist). Chemotherapy is often recommended.

Will I need radiotherapy afterwards?
Not usually, however, it will be recommended if the tumour is close to the resection margins.

Will I be able to eat normally afterwards?
Yes, once the stomach has settled down you should eat normally. Many patients will require supplements of pancreatic juices.

What are the chances of cure?
This depends on a number of factors and can often only be truly estimated after the resection and pathology examination of the tumour.

Will I need further check ups into the future?
Yes, it is generally advisable to have regular blood tests and scans for at least five years after a resection so that, if tumour is to recur, it can be diagnosed early.

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