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In medicine, a pancreatectomy is the surgery of all or part of the pancreas. Several types of pancreatectomies exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy.
The pancreas is located behind the stomach. It is divided into the head, neck, body and tail. Some people have a fifth part of the pancreas known as the uncinate process. The pancreas contains a main pancreatic duct where the exocrine molecules collect and then drain into the duodenum via the common bile duct. There is also an accessory pancreatic duct that drains above the main duct straight into the duodenum.
Blood supply to the pancreas comes from the celiac artery and the superior mesenteric artery, branches of the aorta.
A distal pancreatectomy is removal of the body and/or tail of the pancreas. It is considered the standard procedure for cancer lesions found in the body or tail of the pancreas. The surgery is considered safe, with low morbidity and mortality, with the exception of in the case of pancreatic adenocarcinomas, a type of cancer that has a poor prognosis. Both open and Laparoscopy have been used for this type of surgery. Robot-assisted pancreatectomy also offers benefits in the morbidity and mortality.
A segmental pancreatectomy is used to remove part of the pancreas so that there is not an excess of loss of pancreatic tissue. It is used in instances pf benign or low-grade tumors of the pancreatic neck and body. A study by Du et. al. published in 2013 showed decreased intraoperative Bleeding and risk of post-operative diabetes, however, there was an increase in pancreatic fistula rate in patients that underwent a middle segmental pancreatectomy.
A total pancreatectomy is the complete removal of the pancreas. It is a surgery used to remove the entire pancreas for issues such as chronic pancreatitis or advanced pancreatic cancers if non-surgical techniques do not work. This surgery is known to have disadvantages, however, over the years, surgical techniques as well as the surgical outcomes have improved. Total removal of the pancreas can lead to an insufficiency of hormones produced.
In total pancreatectomy, the gallbladder, distal stomach, a portion of the small intestine, associated and in certain cases the spleen are removed in addition to the entire pancreas.
TP-IAT (total pancreatectomy with islet autotransplantation) has also gained respectable traction within the medical community. These procedures are used in the management of several conditions involving the pancreas, such as benign , pancreatic cancer, and pancreatitis. TP-IAT is used to prevent post-operative diabetes and the subsequent complications. The islet cells are isolated from the explanted pancreas into the portal vein in order to help mitigate the loss of endocrine function following total pancreatectomy.
Complications also include Fistula, or the formation of an abnormal connection between two organs, and pancreatic leakage, where digestive enzymes can leak through the formation of the fistulas. Treatment for pancreatic leaks after surgery can include stenting and occlusion of the pancreatic duct, the use of octreotide, a drug that mimics somatostatin which inhibits secretion from the pancreas, or two other types of surgeries that remove part of the stomach or small intestine along with the pancreas.
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