Surgical Procedures: Pancreatectomy for Pancreatic Carcinoma

Author: OncoLink Team
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What is a pancreatectomy and how is it performed?

The pancreas is a pear-shaped gland that sits between the stomach and spine. There are three parts to the pancreas: the head, the body, and the tail. The pancreas makes digestive enzymes and hormones that regulate blood sugar.

A pancreatectomy is the removal of part or all of the pancreas. It can be used to treat some cases of pancreatic cancer. There are two types of pancreatectomy:

  • Distal Pancreatectomy: The body and tail of the pancreas are removed. Often, the spleen is also removed. There are two ways that a distal pancreatectomy can be done:
    • Open Distal Pancreatectomy and Splenectomy: Removal of the pancreatic body and tail, and the spleen through an open incision (cut).
    • Laparoscopic Distal Pancreatectomy: Removal of the body or tail of the pancreas via laparoscopy. Laparoscopy is the use of many small incisions that surgical tools are placed through. 
  • Total Pancreatectomy: Removal of the whole pancreas, part of the stomach and small intestine, common bile duct, gallbladder, spleen and lymph nodes.

What are the risks of a pancreatectomy?

There are risks and side effects related to having a pancreatectomy. Risks and side effects may be:

  • Pancreatic fistula (Leakage of pancreatic juice from the place that attaches the pancreas to the intestine).
  • Gastroparesis/gastric ileus (Stomach paralysis).
  • Delayed gastric emptying. 
  • Long term digestive complications such as bowel habit changes, malabsorption, need to change your diet, diabetes, infection and weight loss.
  • Bleeding.
  • Infection.

What is recovery like?

The hospital stay for a pancreatectomy is often one to three weeks. While in the hospital you may have: 

  • Abdominal drains to drain extra fluid. 
  • Nasogastric (NG) tube (tube placed into your nose and down into your stomach) to keep your stomach empty.
  • Bladder catheter to empty urine from your bladder. 

Depending on your situation, you may also have: 

  • Epidural tube to deliver pain medications. 
  • Feeding tube placed into your stomach to provide nutrition. 

You may leave the hospital with some of these drains or tubes. You may also need nutrition that is given into a vein, which is called total parenteral nutrition, or TPN.

Before leaving the hospital, your medical team will discuss with you the medications you will be taking for blood clot and infection prevention, and pain management.

Your healthcare team will give you information on your diet following surgery. Digestive enzyme supplements may be needed to prevent diarrhea, aid in food digestion, and regulation of blood sugar levels. This may be temporary or lifelong, depending on your situation.

Recovery takes anywhere from 4-8 weeks. Your healthcare provider will talk to you about activity restrictions while you are at home. Often, it is recommended that you:

  • Walk as much as possible.
  • Do not drive while taking narcotic medications for pain.
  • No heavy lifting, pushing, twisting, bending or pulling until cleared by your team.
  • Eat small frequent meals. Take supplements and enzymes as directed.
  • Prevent constipation by drinking fluids and/or taking stool softeners.
  • If insulin is required, take it as directed.

What will I need at home?

  • Thermometer to check for fever, which can be a sign of infection.
  • Loose clothing.
  • Incisional care supplies will likely be provided to you at the hospital.

Symptoms to report to your healthcare team include:

  • Fever. Your team will tell you at what temperature they should be contacted. 
  • Chills, incisional/drain site drainage, swelling, separation or redness, change in the drainage (foul-smelling and/or creamy).
  • Change in the amount of or a total stop of drainage from the drain.
  • Any new or worsening pain. 
  • Nausea, vomiting, diarrhea and/or constipation.
  • Inability to eat.

Care of Incision

You will be told how to care for your incision before you leave the hospital. Often, it is recommended that you:

  • Wear loose clothing.
  • Wash the incision very gently with soap and water, patting dry with a clean towel when finished.
  • Do not tub bathe or immerse yourself in water. 
  • Do not apply any lotions, powders or ointments unless you are told to do so by your healthcare team.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

  • Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

References

American Cancer Society. Surgery for Pancreatic Cancer. 2019. 

National Cancer Institute. Pancreatic Cancer Treatment (PDQ) - Patient Version. 2018. 

Pancreatic Cancer Action Network. Surgery

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