Pancreas Surgery - Whipple procedure – Pancreatectomy surgery– Surgery for pancreatic cancer - Pancreatic surgery – Pancreaticoduodenectomy

Common types of Pancreas Surgery

Pancreaticoduodenectomy (Whipple procedure)

This is required for tumours and other conditions affecting the head of the pancreas or surrounding organs (e.g. distal bile duct). It involves the removal of the head of the pancreas, a portion of the small intestine, the gallbladder, and the bile duct. The remaining organs are then reconnected to ensure the continued flow of digestive juices and bile.

Distal pancreatectomy

This involves the removal of the tail and a portion of the body of the pancreas. It is often performed for tumours or other conditions affecting the left side of the pancreas. Due to shared blood supply and lymphatic drainage, patients can also require simultaneous removal of the spleen.

Total pancreatectomy

In this procedure, the entire pancreas is removed, along with the spleen and sometimes part of the stomach, small intestine, or bile duct. This surgery is usually performed for extensive pancreatic cancer or severe cases of chronic pancreatitis.

There are several other pancreatic operations (e.g. Necrosectomy, Enucleation, Frey’s procedure) which are required in highly selected circumstances

Laparoscopic/ Robotic pancreatic surgery
Pancreatic surgery has traditionally been done via an open approach with a large incision in the upper abdomen. However, in expert hands, major pancreatic surgery can be done via either a laparoscopic or robotic approach. 

This allows surgery to be completed via small (8mm to 12mm) incisions and facilitates faster recovery in and out of hospital with less blood loss and a lower risk of complications. The laparoscopic or robotic approach may not be suitable in all patients and these decisions are made on an individualised basis in a multidisciplinary setting.

Pancreatectomy and vascular resection
One important aim of surgery for pancreatic cancer is to remove the entire cancer with a margin of healthy tissue. Sometimes, cancers of the head of the pancreas can be right next to the portal vein or superior mesenteric vein (SMV). This is a major vein that drains blood from the gut to the liver.

These cancers are defined as borderline-resectable and can require simultaneous resection and reconstruction of the portal vein or SMV. This is highly specialised surgery conferring additional risk and is performed by a specialist HPB surgeon. If a patient requires this, it is usually able to be anticipated based on scans done before surgery and will be discussed during the consultation and when obtaining consent for surgery.

Risks and complications
Pancreatic surgery is complex and often performed in elderly, frail individuals who may have cancer. 

Risks include:

• Death (3%)
• Need for further treatment including urgent reoperation
• Leakage from the pancreas/ bile duct/ intestines causing infection
• Bleeding
• Nutritional problems causing weight loss
• Digestive symptoms including delayed gastric emptying
• Medical problems from the stress of surgery such as heart attack, pneumonia, blood clots

The risks of surgery and how they apply to each patient are usually discussed during any consultation when surgery is planned and again when consent for surgery is obtained.

Recovery after pancreatic surgery
Recovery from pancreatic surgery can be demanding. Although most patients are in hospital for about seven days, a prolonged hospital stay can be required. Patients often require pain management, intravenous fluids, and nutritional support during the initial recovery period. A subset of patients may go home with extra nutritional support such as a temporary feeding tube or with a drain in to prevent late infection.

Recovery out of the hospital can also be a gradual journey depending on the reasons for surgery (e.g. cancer) and underlying health and age of the patient. Specific issues that patients face can include fatigue, low appetite and the inability to eat big meals or other digestive problems such as nausea. Patients with pancreas cancer also often require chemotherapy which can affect recovery.

Follow-Up Care
Regular follow-up visits with your surgeon are essential for individuals who have undergone pancreatic surgery. These visits are important for monitoring the recovery process, managing any complications, and ensuring that the recovery is proceeding appropriately.