medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...

, a pancreatectomy is the surgical removal of all or part of the

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...

. Several types of pancreatectomy exist, including

pancreaticoduodenectomy A pancreaticoduodenectomy, also known as a Whipple procedure, is a major surgical operation most often performed to remove cancerous tumours from the head of the pancreas. It is also used for the treatment of pancreatic or duodenal trauma, or ch ...

(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 tumor Pancreatic tumors ( Pancreatic cancer) are often broken down into exocrine or endocrine tumors. Each different type of pancreatic tumor has a different appearance when examined under a microscope. These unique microscopic features and genetic marker ...

s, pancreatic cancer, and

pancreatitis Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic pancr ...

Indications

It is performed for a variety of reasons, including: *

Inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

** Necrotising

** Chronic pancreatitis with pain *

Trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

Neoplasms A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

** Adenocarcinoma (85%) **

Cystadenoma Cystadenoma (or "cystoma") is a type of cystic adenoma. When malignant, it is called cystadenocarcinoma. Classification When not otherwise specified, the ICD-O coding is 8440/0. However, the following classifications also exist: By form * sero ...

(mucinous/serous) **

Cystadenocarcinoma Cystadenocarcinoma is a malignant form of a cystadenoma and is a cancer derived from glandular epithelium, in which cystic accumulations of retained secretions are formed. The neoplastic cells manifest varying degrees of anaplasia and invasivenes ...

Islet cell The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...

tumors (

neuroendocrine Neuroendocrine cells are cells that receive neuronal input (through neurotransmitters released by nerve cells or neurosecretory cells) and, as a consequence of this input, release messenger molecules (hormones) into the blood. In this way they bri ...

tumors) ** Papillary cystic neoplasms **

Lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enla ...

Acinar cell Centroacinar cells are spindle-shaped cells in the exocrine pancreas. They represent an extension of the intercalated duct into each pancreatic acinus. These cells are commonly known as duct cells, and secrete an aqueous bicarbonate solution und ...

tumors * Severe

hyperinsulinemic hypoglycemia Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. Hypoglycemia due to excess insulin is the most common type of serious hypoglycemia. It can be due to endogenous or injected insulin ...

Types

The most common surgical procedure involving removal of a portion of the pancreas is called a

Diagram showing how the bowel is joined back together after a total pancreatectomy CRUK 137

Among common consequences of complete or nearly complete pancreatectomy are deficiencies of pancreatic endocrine or exocrine function requiring replacement of insulin or

digestive enzyme Digestive enzymes are a group of enzymes that break down polymeric macromolecules into their smaller building blocks, in order to facilitate their absorption into the cells of the body. Digestive enzymes are found in the digestive tracts of anima ...

s. 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 The term ''diabetes'' includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces ...

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 Islet transplantation is the transplantation of isolated islets from a donor pancreas into another person. It is an experimental treatment for type 1 diabetes mellitus. Once transplanted, the islets begin to produce insulin, actively regulating th ...

exists to help mediate the loss of endocrine function following total pancreatectomy.Common Signs of Pancreatic Cancer
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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

Indications

Types

Prognosis

See also

References

External links