Total pancreatectomy

A Total Pancreatectomy is a surgical procedure wherein the entire pancreas is removed. This procedure may be necessary to treat various conditions, notably pancreatic cancer. However, it's a complex operation that carries a high risk of complications and long-term implications for the patient.

Diagram showing the area removed for a total pancreatectomy

Indications

A total pancreatectomy might be performed for a variety of reasons, including:

• Pancreatic cancer that involves the entire organ.
• Chronic pancreatitis that doesn't respond to other treatments.
• Multiple endocrine neoplasia type 1 (MEN1), a rare inherited disorder.
• Cystic lesions or tumors scattered throughout the pancreas.
• Benign tumors or cystic disease that affects the entire pancreas.

Procedure

During a total pancreatectomy:

• The pancreas, as well as the gallbladder, part of the stomach, part of the small intestine, the common bile duct, and the spleen, may be removed.
• The end of the stomach is then attached to the jejunum, a part of the small intestine, to allow food to move through the digestive system.
• The remaining bile duct and the intestine are also connected, ensuring the flow of bile.

Complications

Like all surgeries, total pancreatectomy carries risks. Complications may include:

• Infections.
• Bleeding.
• Blood clots.
• Leaking from the newly connected areas of the digestive system.

Life After Pancreatectomy

Post-operation, patients will become completely diabetic and will need lifelong insulin replacement therapy because the pancreas produces insulin. Additionally, since the pancreas produces enzymes necessary for digestion, patients will need to take enzyme replacement therapy to assist with digestion.

Dietary Considerations

Post-surgery, patients will need to:

• Eat smaller meals more frequently.
• Limit the intake of sugary foods and drinks.
• Take vitamins and other nutritional supplements.
• Consume a low-fat diet.

Prognosis

The outcome after a total pancreatectomy depends on the underlying reason for the surgery. For patients with pancreatic cancer, prognosis will largely depend on the stage of the cancer at the time of surgery.

See Also

• Pancreas
• Pancreatic Cancer
• Pancreatitis
• Diabetes Mellitus

References

• Lillemoe, K.D., Yeo, C.J., & Cameron, J.L. "Pancreatic Surgery: Current Surgical Therapy, 10th Edition. Saunders, 2011.
• Warshaw, A.L., & Fernández-del Castillo, C. "Pancreatic Carcinoma. The New England Journal of Medicine, 1992.

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