Pancreas Surgery

What Is The Pancreas?

The pancreas is a dual function gland that has both digestive roles (breaks down food) and endocrine roles (control blood sugar). It lies transversely, deep in the abdomen in front of the spine, aorta, and inferior vena cava.

What Is Pancreatic Cancer?

This is a malignant growth of the pancreas. There are 2 main types. Approximately 95% of the cancers are adenocarcinomas while 5% are neuroendocrine tumors. Adenocarcinomas are often highly fatal with fewer than 20% of patients being operable at the time of diagnosis. If the cancer is metastatic (spread to other organs) the median survival is about 6months. If it is locally advanced (invading major artery or vein), the median survival is 9 to 12 months. If it is operable, the median survival is 14 to 24 months with 20% patients living 5 years. Surgery is necessary for a chance at cure. Many neuroendocrine tumors are benign or slow growing, but if neglected can be fatal.

What Is Pancreatitis?

This is inflammation of the pancreas, in which digestive enzymes are activated in the pancreas instead of the intestine. The etiology for most patients is either from alcohol or gallstones. Other etiologies include ERCPs (endoscopic retrograde cholangiopancreatography), some drugs, and elevated triglycerides. Typically surgery is unnecessary, except for gallstones, abscesses, infected phlegmons, or pseudocysts.

Pancreas Surgeries

• Whipple: this is the removal of the head of the pancreas, duodenum, bile duct/gallbladder, proximal intestine and possibly part of the stomach. This is a major operation lasting 4 to 7 hours, with 50% of patients having a complication, and 5 to 10% of patients dying within 30 days of the surgery.
• Distal pancreatectomy: this is the removal of the tail of the pancreas and usually the spleen. It is a major operation, but significantly safer than a Whipple. The length of the surgery is 2 to 4 hours, has a 20 to 30% complication rate and a mortality of 2 to 4 %.
• Laparoscopy: often used immediately before major pancreatic surgery to rule out metastatic disease or as part of a distal pancreatectomy for small distal tumors close to the spleen.
• Pseudocyst: if an early presentation, can often be drained laparoscopically. If the cyst is more mature (> 6 weeks), then it generally must be anastamosed (connected) to the stomach or small intestine.
• Puestow procedure: also known as a longitudinal pancreaticojejunostomy): This is typically done for chronic pancreatitis in which the pancreatic duct greater then 1cm

Pre-Op Preparation

• ERCP, CT scan, Endoscopic ultrasound and possibly cardiac and pulmonary evaluation.
• Do not take blood thinners 5 days before surgery.
• Frequently you will be admitted the day before surgery for a bowel prep and final blood work.
• You will be on clear liquids the day before your surgery.
• Do not eat and drink within 6 hours of surgery.
• If you have had prior Staph infections, please let your surgeon know.

Post-Op Care

• If a Whipple has been performed, most patients will be discharged with a gastrostomy tube (a tube that goes into the stomach). This tube can be used to decompress (empty) the stomach for nausea, or can also be used to supplement feeding.
• About 10% of patients will be discharged with a drain for pancreatic secretions. This will require emptying twice a day. You will be instructed in the hospital.
• You can shower; walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 3 weeks.