What Is Pancreatic Resection?
Pancreatic resection, also called pancreatectomy, is a surgical procedure in which part or, in some cases, all of the pancreas is removed.
When Is Pancreatic Resection Performed?
1. Pancreatic Tumors and Cancer
Pancreatic resection may be performed for tumors or cancers involving:
- The head, body, or tail of the pancreas
- Periampullary tumors
- Cancers involving nearby organs, such as the duodenum, bile duct, or gallbladder
- Cystic pancreatic tumors (cystadenocarcinoma)
- Malignant neuroendocrine tumors
- Metastatic tumors that have spread from another organ
- Lymphoma
2. Benign Pancreatic Tumors
Surgery may also be considered for certain noncancerous or potentially malignant pancreatic tumors, including:
- Cystadenomas, including mucinous and serous types
- Neuroendocrine tumors
- Acinar cell tumors
- Solid pseudopapillary tumors
- Islet cell tumors
3. Chronic Pancreatitis
4. Pancreatic Injuries
Types of Pancreatic Resection
1. Whipple Procedure
The Whipple procedure, also called a pancreaticoduodenectomy, is one of the major operations used for diseases involving the head of the pancreas and nearby structures. The Whipple procedure is performed for:
- Periampullary tumors
- Tumors of the pancreatic head
- Duodenal tumors
- Bile duct tumors
- Selected benign tumors of the pancreatic head
What Is Removed?
The operation may involve removing:
- The head of the pancreas
- Part of the stomach
- Part of the bile duct
- The duodenum
- A portion of the intestine
What Connections Are Made?
After the diseased structures are removed, the digestive system must be reconstructed. This may involve connecting:
- The pancreas to the small intestine (pancreatojejunostomy)
- The bile duct to the small intestine (hepaticojejunostomy)
- The stomach to the small intestine (gastrojejunostomy)
- The remaining intestine to the small intestine (enteroenterostomy)
2. Distal Pancreatectomy
A distal pancreatectomy removes the body and/or tail of the pancreas. During this operation, the spleen may either be:
- Preserved (spleen preserving)
- Removed (without spleen preserving)
3. Middle/Segmental Pancreatectomy
A middle or segmental pancreatectomy removes tumors from the middle part of the pancreas.
4. Total Pancreatectomy
In certain very complex situations, the entire pancreas may need to be removed. After a total pancreatectomy, the patient will need:
- Lifelong insulin treatment to control blood glucose (diabetes)
- Pancreatic enzyme supplements to help digest food
Possible Complications of Pancreatic Resection
Pancreatic surgery is complex and can have significant complications, including:
- Pancreatic anastomotic leakage, reportedly occurring in about 1 in 10 patients
- Biliary, intestinal and gastric anastomotic leak
- Bleeding
- Delayed stomach emptying or slow digestion (delayed gastric emptying)
- Reduced pancreatic function (pancreatic insufficiency)
- Complications related to anesthesia
- Infection at the surgical site
- Chest or lung infection
- Deep vein thrombosis (DVT)
- Other postoperative complications
Outcomes of Pancreatic Surgery
In case of pancreatic cancer:
- 5-year survival rate of approximately 15% to 25% in most cases.
- For selected benign pancreatic conditions or pancreatic injuries, complete recovery may be possible after appropriate surgery and follow-up.
Factors That Affect the Success of Pancreatic Resection
Several factors can influence the outcome of pancreatic cancer surgery:
- A smaller tumor, particularly one less than 2 cm, is generally associated with more favorable outcomes.
- The tumor should ideally be completely removed with negative resection margins, meaning no cancer cells are found at the edges of the removed tissue.
- There should ideally be no spread to the lymph nodes (no lymph node metastasis).
- A well-differentiated tumor generally has more favorable biological characteristics than a poorly differentiated tumor.
- No perineural or blood vessel invasion.
Conclusion
- Pancreatic cancer is more treatable when it is detected at an early stage and can be completely removed.
- Before pancreatic surgery, the patient's overall health and other medical conditions should be carefully evaluated and treated when necessary (comorbid conditions).
- Not every patient with pancreatic cancer will benefit from pancreatic resection in the same way. Careful patient selection is therefore essential.
- Pancreatic surgery is highly complex, and outcomes are generally better when it is performed by an experienced pancreatic surgeon at a specialized center that performs a high volume of pancreatic operations.