What is a total pancreatectomy?
A total pancreatectomy is
performed to treat pancreatic cancer. The procedure involves the removal of the
entire pancreas, as well as the spleen, gallbladder, common bile duct, and
portions of the small intestine and stomach. By removing the pancreas, the chance
of removing the entire tumor is increased. This procedure is used when
malignant cells have invaded most of the pancreatic tissue.
Unfortunately, a total
pancreatectomy leaves the patient unable to produce pancreatic enzyme for
digestion and insulin for controlling blood glucose level. When the entire pancreas is
removed, the endocrine cells in it are also removed, which will leave you with
no islet cells. Because islet cells make insulin, which controls blood sugar
levels in the body, removal of the entire pancreas will result in diabetes. You
will then be dependent on insulin injections. And will
be required to take supplemental enzymes and insulin for the remainder of your life.
Total pancreatectomy is
sometimes used prophylactically to prevent onset of pancreatic cancer in
patients found to have precancerous conditions like Intraductal Papillary
Mucinous Neoplasms (IPMN). While the procedure ensures pancreatic cancer will
not develop in the future, it also guarantees insulin-dependent diabetes and
should be discussed thoroughly and carefully with your physician.
Not long ago, total
pancreatectomy (TP) has been abandoned by many surgeons because of its lack of
benefits and other major drawbacks. The potential benefits of TP, including its
cancer treatment related as well as its technical advantages, did not prove to
be valid. Problems associated with insulin-deprived diabetes mellitus and high
perioperative morbidity and mortality rates were not easily manageable.
However, in the new era of pancreatic surgery, new indications for TP have been
defined. These have been paralleled by improvements in surgical technique,
multidisciplinary management and postoperative intensive care. These factors
have transformed TP into a relatively safe and reasonable surgical procedure
with excellent perioperative morbidity and mortality, as well as good long-term
outcome.
The Procedure
Most patients stay in the
hospital for 7 to 10 days. Because of the location of the pancreas, it may be
necessary to remove part of the stomach, the duodenum, the end of the common
bile duct, the gallbladder, and the spleen.
The surgeon will
reconnect your stomach and remaining portion of your common bile duct to the jejunum.
The jejunum is the second part of the small intestine. This ensures that food
and bile flow into your small intestines. The operation takes 4 to 6 hours.
Preparing for your Surgery
Please contact your
insurance company to verify coverage and determine whether a referral is
required. You will be asked to pre-register with the appropriate hospital and
provide demographic and insurance information. This must be completed at least
five to ten days before the date of surgery. Your surgeon will give you
specific instructions on how to prepare for your surgery.
The spleen is part of
your body’s immune system. If it will be removed, your doctor may want you to
have a Pneumovax vaccination before the surgery. This will help protect
you against certain types of infection. You can get it before the operation on
a day when you come in to see the doctor. You can also get it after your
operation when you return for a follow-up visit.
Your bowels must be clean
before surgery. You may have to complete a bowel preparation procedure at home.
Your nurse will give you these instructions and review what you must do. You will get a booklet called Getting
Ready for Surgery. You will also get a fact card called Common Medicines
Containing Aspirin and Nonsteroidal Anti- Inflammatory Drugs. If you have
not received these, please ask your nurse for them. Review them carefully. They
explain what you should do before surgery. You must stop taking vitamin E and
any medicine that has aspirin in it 10 days before your surgery. You must stop
taking drugs such as ibuprofen (Motrin or Advil) 48 hours
before surgery. The fact card lists all of the common medicines that have these
drugs. It also lists the medicines that you can take instead.
Anesthesia
You will have a
pre-operative interview with an anesthesiologist who will ask you questions
regarding your medical history. A pancreatectomy is performed under general
anesthesia which will keep you asleep during surgery.
During the Surgery
The goal of a total
pancreatectomy is to remove the entire pancreas and the attached organs. First,
the end of the stomach is divided off and detached. This part the stomach leads
to the small intestine, where the pancreas and bile duct both attach. In the
next step, the pancreas is removed along with the connected section of the
small intestine. The common bile duct and the gallbladder are also removed. To reconnect
the intestinal tract, the stomach and the bile duct are connected to the small
intestine.
Several tubes are
implanted for postoperative care. To prevent tissue fluid from accumulating in
the operated site, a temporary drain leading out of the body may be implanted.
Also, a Gastrostomy or G-tube leading out of the stomach will help prevent
nausea and vomiting, and a Jejunostomy or J-tube inserted into the small
intestine will serve as a channel for supplementary feeding.
Recovery
You
will be ready to go home when you:
- Can eat a regular diet.
- Show no signs of complications.
Your
doctor will give you discharge instructions and prescriptions for any medicines
you need. Your nurse will review these instructions with you. You will get a
printed copy to keep. The case manager will arrange for any home care before
you leave. Many patients need visiting nurse services at home. In general, your
first post-operative visit will be 10 to 14 days after you leave the hospital.
This will be indicated on your discharge instruction sheet. Please call your
doctor’s office to schedule the appointment.
Ability
to return to work and/or normal activities varies among patients. You will be encouraged to return to normal
activities, such as showering, driving, walking up stairs, light lifting and
work, as soon as you feel comfortable. No heavy lifting or straining for six to
eight weeks after open surgery. If taking narcotic medications for pain, you
should not drive.
Note that you will have a
single long scar as a result from the incision.
Special Instructions
- A common complaint that patients have after this surgery is lack
of appetite. Try to eat small amounts of your favorite foods often
throughout the day. It is important to eat a balanced diet. It will help
your body heal faster. It can help you keep your blood sugar levels within
your target range. It is important that you do not skip entire meals
because this could cause low blood sugar or hypoglycemia. Low blood sugar
can be very serious if it is not treated. The diabetes nurse educator will
give you booklet on how to treat it and other information to help you
manage your diabetes. Always carry a source of sugar with you. It can be
hard candy or glucose tablets. Take it immediately if you have any
symptoms of hypoglycemia.
- Feeling tired (fatigue) is common after surgery, and may last for
6 to 8 weeks. This will improve slowly over time. Try to increase your
activity level every day to help manage your fatigue. Get up, get dressed,
and walk. You may need a nap during the day, but try to stay out of bed as
much as possible so you will sleep at night. Ask your nurse for the
booklet, Handling Fatigue During and After Cancer Treatment, if you
haven’t already received it.
- When you go home, you may still have some incisional pain that requires pain medicine. Take it as directed when you need it. Remember, your pain medicine will let you do the things that will help you gain strength and recover faster. They are important. However, pain medicines cause constipation. Take extra fluids and fiber, and use a stool softener such as docusate (Colace). As the pain lessens, acetaminophen (Tylenol) may be enough to control it.
Managing Diabetes
The thought of being
diabetic may seem overwhelming. You will be one of millions who live with
diabetes. Most live normal lives. During your hospital stay, you will see a
diabetes nurse educator. This nurse will work closely with you and your care
partner to prepare you for managing your diabetes. You will be taught:
- How diabetes affects your body.
- What foods to eat and what ones to avoid.
- How to check your blood sugar.
- How to give yourself an injection of insulin.
You must see a doctor
close to home who will help you manage your diabetes after you leave the
hospital. An endocrinologist is a doctor who specializes in diabetes.
Sources and
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