In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomies exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy.

History

Pancreatic surgeries have been reported as early as the 1800s, however the first successful complete pancreatectomy was reported in 1944. Surgery on the pancreas is complex, at times requiring both the resection, or removal of parts or the entire organ, as well as anastomosis, or the connection of different parts of the digestive system. Advances in technology have allowed for the improvement in outcomes, reduction of complications, and improvement in surgical techniques.

Pancreatic anatomy and function

thumb|Pancreas and surrounding structures.

The pancreas is a digestive and endocrine organ that serves as a gland. It releases endocrine and exocrine hormones to help with metabolism and digestion.

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. 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. A study by Du et. al. published in 2013 showed decreased intraoperative hemorrhage and risk of post-operative diabetes, however, there was an increase in pancreatic fistula rate in patients that underwent a middle segmental pancreatectomy. 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 lymph nodes 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 tumors, 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.

Contraindications

Reasons why patients should not receive a specific treatment to the disease/illness are known as contraindications. Contraindications to pancreatectomies include a patient's other medical history or comorbidities, poor functional status of the patient, and/or bleeding issues. Contraindications to pancreatectomy also can vary by type. In distal pancreatectomies, lesions that are not fully able to be removed are considered contraindications. after pancreatectomy and a study by Kim et al. determined that patients with BMIs >25 kg/m<sup>2</sup> had higher incidences of pancreatic diabetes after distal pancreatectomy.

See also

  • List of surgeries by type

References

  • The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of total pancreatectomy procedure