Pancreas Problems

There are both benign and malignant conditions of the pancreas which may be amenable to surgical treatment. The benign conditions include pseudocysts which have not responded to drainage through the skin, chronic pancreatitis and the pre-malignant condition known as intraductal papillary mucin-producing neoplasm (or tumor) (IPMN or IPMT). The malignant conditions include pancreatic adenocarcinoma (the most common and aggressive form of pancreatic cancer), cyst-adenocarcinoma, ampullary carcinoma and neuroendocrine tumors (such as islet-cell carcinoma).

This is probably the Whipple procedure, which consists in the removal of the head of the pancreas with the attached loop of the duodenum (known as the duodenal-C, due to its shape) and reattachment of the stomach, bile duct and remaining pancreas to the jejunum (the second portion of the small bowel). Dr. Stieber prefers to perform the pylorus-sparing variation of the Whipple procedure as often as possible since it provides a more physiologic (natural) reconstruction of the GI tract. This is the operation for “classic” cancer of the pancreas or IPMN located in the head of the pancreas. Unfortunately, in at least 50% of the patients with cancer of the head of the pancreas, the operation is not feasible, due to an invasion of cancer into the big veins that run behind it. Even when cancer can be removed, the chances of metastatic disease in the liver are very high, but the Whipple operation is the only modality that has at least a potential for cure.

These tumors, just like the ones in the head of the pancreas, are very indolent and, by the time they have started to produce symptoms, they have usually progressed beyond the point where surgical removal is of any benefit. When discovered incidentally, such as on CT scans performed for other conditions, they are highly treatable by resecting the body/tail of the pancreas, with or without the spleen. This is also the operation for IPMN in the tail of the pancreas (with spleen sparing). If it is determined before surgery that the spleen may have to be removed, the patient receives several vaccines prior to the operation, to decrease the risk for some types of infections which the spleen normally helps to combat.

Yes, a distal pancreatectomy (removal of the tail) can be done with a hand-assisted laparoscopic technique under certain limited circumstances.

If there are no complications (though about 1/3 of the patients do have some complication, especially the ones with pancreatic cancer), the stay in the hospital is about 7-8 days, and complete recovery occurs in about 2-3 months. There is a drain placed in the abdomen, which has a bulb outside the body providing suction. Most patients go home with the drain in place and have it removed during one of the office visits. Some patients may have some vague GI problems for many months, but this is quite infrequent. The most common complication is leakage from where the various structures have been reattached to the jejunum (bowel), and especially at the pancreas remnant. Leaks are normally managed with prolonged drainage and, sometimes, with withholding of oral diet, while the patient receives intravenous nutrition.