Pancreatectomy (Pancreas Surgery)

What Is a Pancreatectomy?

A pancreatectomy is a complex surgical procedure to remove all or part of the pancreas, a long, flat organ behind the stomach that produces digestive enzymes and hormones, including insulin. The operation involves deep abdominal access and requires careful management of connections to major blood vessels and shared ducts.

Types of pancreatectomy:

• Distal Pancreatectomy: Removes the body and tail (left side), often including the spleen.
• Pancreaticoduodenectomy (Whipple): Removes the pancreatic head, part of the small intestine, gallbladder, and bile duct.
• Central/Subtotal: Removes the mid-portion while preserving both ends.
• Total Pancreatectomy: Removes the entire pancreas, bile duct, gallbladder, spleen, and part of the small intestine.

Procedures can be performed via open, laparoscopic, or robotic techniques and typically require 4-8 hours under general anesthesia.

Why It's Done

• Pancreatic cancer (primary indication)
• Neuroendocrine tumors (NETs)
• Cystic neoplasms with malignant potential
• Chronic pancreatitis with intractable symptoms
• Pancreatic trauma or severe duct injury

Risks & Complications

Overall complication rates range from 30-50%, with serious complications (Grade III+) occurring in 10-20% of patients. Mortality for elective Whipple procedures at expert centers is 1-5%.

Specific risks include:

• Pancreatic fistula: 5-20%
• Delayed gastric emptying: 10-25%
• Infection/abscess: 5-10%
• Bleeding: 2-5%
• New-onset diabetes: 20-40%
• Exocrine insufficiency: 30-50%
• Bile leak: 1-3%
• Wound infection: 5-10%
• Venous thrombosis: 2-4%

Recovery Timeline

• Hospital stay: 5-10 days (partial resection); 10-14 days (Whipple/total)
• Desk work: 4-6 weeks
• Strenuous activity: 8-12 weeks
• Full recovery: 2-3 months

Initial management involves pain control, clear liquids progressing to soft foods, and enzyme supplementation to aid digestion.

Long-Term Care

• Cancer patients may undergo subsequent chemotherapy
• Blood sugar monitoring essential if partial pancreas remains
• Total pancreatectomy requires lifelong insulin and enzyme replacement
• Nutritional counseling supports recovery and strength restoration

Surgeon Specialists

Hepatopancreatobiliary (HPB) Surgeons or Surgical Oncologists perform these procedures. Research demonstrates significantly better outcomes at high-volume centers (over 20 Whipple operations annually per surgeon), with reduced mortality from 8% to less than 3%.