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In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. In recent years, the 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 tumors,
pancreatic cancer Pancreatic cancer arises when cell (biology), cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a Neoplasm, mass. These cancerous cells have the malignant, ability to invade other parts of t ...
, and pancreatitis.


Indications

It is performed for a variety of reasons, including: * Inflammation ** Necrotising pancreatitis ** Chronic pancreatitis with pain * Trauma * Neoplasms **
Adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or ...
(85%) ** Cystadenoma (mucinous/serous) ** Cystadenocarcinoma ** Islet cell tumors ( neuroendocrine tumors) ** Papillary cystic neoplasms ** Lymphoma ** Acinar cell tumors * Severe hyperinsulinemic hypoglycemia


Types

The most common surgical procedure involving removal of a portion of the pancreas is called a pancreaticoduodenectomy. Among common consequences of complete or nearly complete pancreatectomy are deficiencies of pancreatic endocrine or exocrine function requiring replacement of
insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...
or digestive enzymes. The patient immediately develops type 1 diabetes, with little hope for future type 1 diabetes treatments involving the restoration of endocrine function to a damaged pancreas, since the pancreas is either partially or completely absent. Type 1 diabetes can be treated with careful blood glucose monitoring and insulin therapy. Because the pancreas is responsible for the production of many digestive enzymes, a pancreatectomy should only be given as an option for pancreatic disease which is life-threatening, such as pancreatic cancers. It is very important to note that even after a pancreatectomy, pain still exists in most patients. A distal pancreatectomy is removal of the body and tail of the pancreas.


Prognosis

After a total pancreatectomy, the body no longer produces its own insulin or pancreatic enzymes, so patients have to take insulin and enzyme supplements. Those who were not already diabetic become so. Glycemic control is challenging even for relatively young and healthy apancreatic people, owing to the digestive challenges of not having endogenous insulin and pancreatic enzymes under autonomic control. It can be insurmountably challenging depending on age and comorbidities. But overall, quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection. An experimental procedure called islet cell transplantation exists to help mediate the loss of endocrine function following total pancreatectomy.Common Signs of Pancreatic Cancer
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See also

* List of surgeries by type


References


External links


The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of total pancreatectomy procedure
{{Digestive system surgical procedures Surgical oncology Surgical removal procedures Accessory digestive gland surgery Pancreatic cancer