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Where
is the pancreas located and how large is it?
What are the conditions under which surgery is
needed on the pancreas?
Which is the most common operation on the
pancreas?
What happens if the tumor is in the body or tail
of the pancreas?
Can the pancreas be removed laparoscopically?
What is the recovery time after a Whipple
procedure?
Q: Where
is the pancreas located and how large is it?
A: The pancreas is located at the back of the
upper abdomen, extending from the duodenum (the
first portion of the small bowel), across the
midline and slightly upwards to the left, ending
just about at the spleen. It is a smallish
organ, about 5” in length, a bit thicker at the
head (by the duodenum) and tapering towards the
tail.
Q:
What are the conditions under which surgery is
needed on the pancreas?
A: There are both benign and malignant
conditions 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).
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Q:
Which is the most common operation on the
pancreas?
A: This is probably the Whipple procedure,
which consists in removal of the head of the
pancreas with the attached loop of 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 invasion of the cancer into the
big veins that run behind it. Even when the
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.
Q:
What happens if the tumor is in the body or tail
of the pancreas?
A: 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.
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Q:
Can the pancreas be removed laparoscopically?
A: Yes, a distal pancreatectomy (removal of the
tail) can be done with a hand-assisted
laparoscopic technique under certain limited
circumstances.
Q:
What is the recovery time after a Whipple
procedure?
A: 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.
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To set up a
consultation, or if you have other questions
regarding your specific situation, you may
contact our office at 404-508-4320, or email Dr.
Stieber directly at
drstieber@dekalbsurgical.com.
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