What is a total pancreatectomy?

A total pancreatectomy is a pancreatic cancer treatment option that is performed as a last resort option when no other treatments are available.

During a total pancreatectomy, your surgical team will remove your pancreas, gallbladder, common bile duct, duodenum, lymph nodes and spleen.

This procedure requires the expertise of highly trained surgical specialists to ensure positive outcomes.

Who is a candidate for a total pancreatectomy?

A total pancreatectomy is not a commonly used procedure. You may be a candidate for this complex procedure if all other options have failed or are not available. Your doctor and entire surgical team will evaluate your case to determine if a total pancreatectomy is an option for you.

Complications associated with a total pancreatectomy

A total pancreatectomy is a complex and risky procedure. Your doctor will review all potential complications before scheduling surgery. Complications may include:

  • Weight loss — you may lose 15 pounds or more after a total pancreatectomy.
  • Diabetes — patients who have pre-diabetes may be diagnosed with diabetes after surgery because the pancreas has been removed. The pancreas regulates the body’s blood sugar.
  • Pancreatic enzyme insufficiency — because the pancreas has been removed, you may develop pancreatic enzyme insufficiency and need pancreatic enzyme replacement therapy.
  • Delayed stomach emptying  — as the stomach recovers, it may take longer to empty food after surgery.
  • Severe bleeding — some patients may require a blood transfusion after a total pancreatectomy.

What to expect during a total pancreatectomy

In preparation for the surgery, your care team will give you a general anesthesia, so you will be asleep during the procedure. You will be attached to a breathing machine, so you are able to breathe under the anesthesia. A tube will also be placed through the nose and into the stomach to help control nausea and vomiting. Your surgeon will then make an incision into the abdomen and inspect the pancreas and surrounding organs.

Once your surgeon has deemed the surgery safe to perform, your surgeon will remove your entire pancreas, part of your stomach, your duodenum (first part of the small intestine), your gallbladder, your spleen and the end portion of your common bile duct. When these organs are removed, your surgical team will reconnect your remaining portion of the stomach to the jejunum (second part of small intestine).

A total pancreatectomy takes from four to eight hours to perform, depending on the complexity of your case.

Recovery from a total pancreatectomy

You may need to stay in the hospital for as long as two weeks after a total pancreatectomy. Directly after the surgery, you will be transferred to a Post Anesthesia Care Unit (PACU) for close monitoring. When you are stable, you will be moved to a surgical hospital floor for further monitoring. You will likely need pain medication to relieve the pain associated with the invasive procedure.

The drainage tubes placed in your abdomen during surgery will remain in place until your surgeon deems it safe to take them out. Some patients will be discharged with the drainage tubes in place. If you need the drainage tubes at home, your surgeon will give you detailed instructions on how to manage them at home.

Your doctor will evaluate your recovery to determine when you can begin eating again. You will need to start with clear liquids and slowly move to regular food as tolerated.

Your doctor will advise you how quickly you can start to move. Unless you have complications, you should be able to sit in a chair and take a shower within two days of surgery. In some cases, you may be given nutrition via an IV to ensure you meet your nutritional needs.

Total recovery time is as long as eight weeks post-surgery. Follow your doctor's instructions on how quickly you can resume your normal routine.

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