What is a distal pancreatectomy?

A distal pancreatectomy is a minimally invasive pancreatic cancer treatment where your doctor removes the body and tail of the pancreas. The pancreas is an organ in the digestive system that helps digest food and produces hormones that help control blood sugar levels and help the body use stored energy from food you have eaten.

Why would you need to get a distal pancreatectomy?

If you have any of the following conditions, you may need to have a distal pancreatectomy:

  • Acinar cell tumors
  • Adenocarcinoma
  • Ampullary cancer - cancer that affects the Vater
  • Cancer in the lower part of the bile duct (distal portion)
  • Chronic pancreatitis
  • Duodenal cancer
  • Inflammation
  • Neuroendocrine tumors - islet cell tumors
  • Lymphoma
  • Neoplasms
  • Papillary cystic neoplasms
  • Severe chronic pancreatitis
  • Severe trauma
  • Severe hyperinsulinemia hypoglycemia

Complications associated with distal pancreatectomy

Although complications associated with a distal pancreatectomy are typically mild, they can become severe if not monitored closely.

Complications may include:

  • A fistula leak can occur if the stitches do not seal properly
  • Weight loss because of your reduced food intake
  • Diabetes can occur if you are prediabetic because when the pancreas is removed, it affects your blood sugar level

If you experience fever over 100.4 degrees, severe pain, nausea, vomiting, diarrhea, constipation or increased redness at the incision site, call your doctor right away.

Advantages of distal pancreatectomy

A distal pancreatectomy is a minimally invasive procedure; therefore, recovery time is faster and side effects are less severe. For frail patients, these benefits are important to help mitigate the risk associated with the procedure.

What to expect during a distal pancreatectomy?

Before the procedure, you will be given a general anesthesia, so you will be asleep. During the procedure, your doctor will fill your abdomen with gas to give your surgeon greater visibility of the pancreas and abdominal cavity. Your surgeon will insert two sets of tubes through your nose, into the stomach. The tubes are used to help prevent nausea/vomiting and help fluids drain out during the surgery and during recovery.

After the tubes are in position, your doctor will make three incisions in the abdominal wall. He will insert a camera into one incision, surgical equipment into another and his hand into the last one. If the tumor is still operable, your surgeon will remove the tumor. In some cases, your doctor will need to remove the spleen as well. The entire procedure will take approximately four hours.

Recovery from distal pancreatectomy

Most patients spend three to five days in the hospital after a distal pancreatectomy. Directly after surgery, you will be transferred to a Post Anesthesia Care Unit (PACU) for careful monitoring.

When stable, you will be moved to a surgical hospital floor where you will be monitored further. If you are in severe pain, your doctor may give you pain medication either by a patient-controlled analgesia pump (PCA pump), injection or mouth.

Your doctor will remove the drainage tubes that have been controlling your vomiting and draining the excess fluids. In more severe cases, you may be discharged from the hospital with drainage tubes still inserted. In these cases, you will be given detailed discharge instructions on how to manage them at home.

You will not be able to eat regular food for at least two to three days after surgery. Your care team will slowly start you on clear fluids and then to other fluids and foods as you recover. You will be able to slowly resume activity a day after surgery and can take a shower within two days after surgery.

Before being discharged, your doctor will review detailed discharge instructions including:

  • Wound care
  • Recovery time
  • Pain management
  • Nutrition
  • How quickly to resume activity level
  • Follow-up appointment schedule

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