Distal Pancreatectomy

The pancreas is the ‘sweetbread’ organ at the back of the abdomen. It is a flat glandular organ. It has a hormonal (endocrine) component that makes insulin and some other hormones. It also has an exocrine function that produces digestive juices that assist in the breakdown of starch, proteins, and fat. These juices are excreted through a duct into the duodenum (the first part of the small intestine) where they mix with the food we eat. The bile duct (bringing bile into the gut from the liver) passes through the pancreas on its’ way to the duodenum

Tumours of the pancreas can be solid or cystic and can arise from the exocrine gland cells or the endocrine gland cells. They can be benign or malignant. Rarely the pancreas is a site for secondaries from cancers elsewhere (particularly melanoma). Most cysts in the pancreas are benign and can be safely watched. Most solid lumps should be removed because of the risk for cancer.

The most common cancer of the pancreas is ‘ductal adenocarcinoma’ This is an aggressive tumour with poor outcomes unless it can be completely removed. Adenocarcinoma of the pancreas is associated with alcohol abuse, smoking, some family cancer syndromes, and a history of chronic pancreatitis, although most patients will have none of these risk factors. Most patients are in an older age group. Unfortunately, most patients with adenocarcinoma of the pancreas present too advanced to be cured by surgery. When the tumour is small, and has not spread, then a resection (removal) can usually be performed. Even after resection only around one in four or five patients will be cured

At a minimum, patients undergoing pancreas surgery will have a CT scan (or sometimes MRI), and blood tests. If the tumour involves the bile duct, then it is sometimes necessary to have an ERCP (Endoscopic Retrograde Cholangio-Pancreatogram) which is a fibreoptic technique through the mouth like a gastroscopy. Sometimes a gastroscopy and ultrasound are used to identify a lump or to determine respectability. It is unusual to require a biopsy prior to surgery.

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 and performed laparoscopically. It is often possible to preserve the spleen, but sometimes not. Most patients recover quickly from this surgery and are discharged after a few days in hospital.

Pancreatic-Duodenectomy : 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. It is now possible for many patients to have the surgery laparoscopically. Following the resection: the bile duct, the stomach and the pancreatic duct all need to be re-joined to the gastro-intestinal system.

The bowel is brought up and joined to the bile duct, the pancreas and then the stomach. Drains are placed near the pancreas and the bile joins to check for leakage.

The post-operative course 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 surgery, patients slowly start oral intake from day 1. Patients can expect 6-12 weeks away from work.

The risks of different complications vary between patients. The risks are higher if the patient is older or has significant other illnesses. Most patients have a straightforward course, but some will have serious complications.

ERCP is a safe and well-tolerated procedure when performed by specialist doctors trained and experienced in the technique. Although complications requiring hospitalisation can occur, they are uncommon. Complications can include:

Pancreatitis (inflammation of the pancreas)

Infections

Bowel Perforation

Bleeding

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Pancreatitis is the most frequent serious complication and causes pain in the abdomen. It is usually mild and settles within a couple of days in hospital with pain relief, bowel rest and intravenous fluids. However, occasionally pancreatitis can more severe, and very rarely can even result in death. Since the risks vary with each patient you should have a detailed conversation with your doctor about the risks to you.