Pancreatectomy

Removal of the pancreas is an operation during which part of the organ or the entire gland is removed. Most often, such an intervention is performed for malignant tumors. In some cases, a more complex operation is necessary for complete removal of the neoplasm — pancreaticoduodenal resection (Whipple procedure), which involves the removal of the head of the pancreas, the duodenum, and other adjacent structures.

At the Oxford Medical medical center in Kyiv, pancreatic operations are performed by a team of experienced surgeons under the supervision of a Doctor of Medical Sciences, a physician of the highest qualification category with over 30 years of work experience. The surgical department is equipped with expert-class equipment for performing complex interventions, and after surgery, patients undergo recovery in a comfortable inpatient facility under round-the-clock medical supervision.

To schedule a consultation with a surgeon at Oxford Medical, call the contact center or use the online appointment form on the website.

In oncological diseases, the decision regarding surgery depends primarily on the possibility of complete tumor removal. International recommendations from the National Comprehensive Cancer Network (NCCN) are used to assess this possibility. They provide for the classification of tumors according to the possibility of surgical removal.

The following categories are distinguished:

• Resectable tumors — neoplasms that can be completely removed without critical involvement of major blood vessels.

• Borderline resectable tumors — neoplasms that are in contact with major blood vessels or partially involve them. In such cases, chemotherapy is often prescribed before surgery to increase the chances of complete tumor removal.

• Unresectable tumors — neoplasms with significant local spread or distant metastases that cannot be completely removed at the time of diagnosis. The mainstay of treatment is usually medical antitumor therapy. In some cases, after this therapy has been administered, the possibility of surgery is reassessed.

Doctors at Oxford Medical emphasize that even when major blood vessels are affected, it is not always necessary to abandon surgical treatment. Modern methods of diagnosis and preliminary antitumor therapy make it possible in some cases to prepare the patient for a complex intervention. The final decision is made after assessing the extent of gastrointestinal oncology and the patient's general condition.

Operations on the pancreas can be performed laparoscopically or by an open approach. The surgical approach is chosen taking into account the location of the tumor, its size, possible involvement of neighboring organs and major blood vessels.

The following methods are used to perform pancreatectomy:

• Laparoscopic method. The surgeon makes several small incisions in the abdomen and inserts a camera and special instruments through them. An enlarged image of the surgical field is displayed on a monitor, which helps the doctor perform precise manipulations. To extract the removed tissues, one of the incisions is enlarged.

• Laparotomic method. The operation is performed through an incision in the anterior abdominal wall, which provides direct access to the pancreas and adjacent structures. This method is more often used for large tumors, vascular involvement, or the need for complex reconstructive stages of the operation.

Minimally invasive access, in appropriate cases, makes it possible to reduce postoperative pain and accelerate recovery. At the same time, for complex interventions, the open method may be safer. The surgeon makes the final decision taking into account the specific features of the disease and the planned extent of the operation.

The operation is performed under general anesthesia. Depending on the extent and complexity of the intervention, it may last from 3 to 8 hours, sometimes longer. In cases of partial removal of the gland, the surgeon preserves its healthy tissues whenever possible. If the operation involves the removal of adjacent organs or their parts, reconstruction of the digestive tract is additionally performed.

The main stages of the operation:

• Assessment of the extent of the disease. After obtaining surgical access, the doctor examines the pancreas, neighboring organs, and blood vessels. If necessary, the boundaries of the affected area are clarified.

• Removal of affected tissues. The surgeon separates the planned part of the gland or the entire organ, divides and manages the corresponding blood vessels. In cases of oncological diseases, regional lymph nodes are removed along with the tumor according to the type of operation.

• Restoration of the digestive tract. After pancreaticoduodenal resection, the surgeon connects the remaining part of the pancreas, the bile duct, and the stomach to the small intestine to restore the passage of food, bile, and pancreatic juice. In other types of operations, the need for and method of such connections may differ.

• Completion of the intervention. The doctor checks the condition of the tissues, the reliability of the connections formed, and the absence of bleeding. If necessary, drains are placed to remove fluid from the abdominal cavity, after which the surgical wound is closed.

After completion of the operation, the patient is brought out of general anesthesia. If necessary, the patient is temporarily transferred to an intensive care unit equipped with mechanical ventilators from the Swiss company Hamilton Medical and other equipment for monitoring vital signs. When the patient's condition stabilizes, the patient is transferred to a comfortable single or double room in the surgical inpatient department, with a separate bathroom, air conditioning, a television, and everything necessary for the stay and recovery.

After the operation, the patient remains in the surgical inpatient department under round-the-clock supervision by medical staff. Doctors monitor the patient's general condition, digestive system function, blood glucose levels, and healing of the postoperative wound. Dressing changes, pain relief, and other necessary medication therapy are provided.

The duration of hospitalization is usually 7–14 days, but it may be longer after complex operations. Returning to usual activities often takes 6–8 weeks, while full recovery sometimes takes several months. Rehabilitation after oncological surgical interventions requires special attention, since after the removal of a malignant tumor, the patient may need additional antitumor treatment.

Nutrition is gradually resumed according to the patient's condition. In the absence of contraindications, drinking water and eating small portions of food may be permitted within the first day. Initially, easily digestible dishes are recommended, gradually expanding the menu depending on their tolerance. If the patient cannot obtain sufficient nutrients in the usual way, the doctor may prescribe nutrition through a special tube or intravenously.

Physical activity is also resumed gradually. Usually, on the day of surgery or the following day, the patient is helped to sit up, get out of bed, and take the first steps. After discharge, daily walks and a gradual increase in activity are recommended. Lifting heavy objects is usually restricted for at least 4–6 weeks, and after complex interventions — for a longer period as recommended by the surgeon.

After removal of the pancreas, nutrition should provide the body with the necessary nutrients without causing excessive strain on the digestive system. The specific features of the diet depend on the extent of the operation, the preserved function of the gland, and food tolerance.

Main dietary recommendations:

• eat 5–6 times a day in small portions, avoiding long intervals between meals;

• give preference to boiled, stewed, or baked dishes;

• include sufficient protein in the diet: lean meat, fish, eggs, and fermented dairy products as tolerated;

• temporarily limit fried, very fatty, and spicy dishes that may worsen well-being;

• gradually introduce vegetables, fruits, and foods high in fiber, observing the reaction of the digestive system;

• drink enough water throughout the day and avoid alcohol.

In cases of insufficient production of digestive enzymes, the doctor prescribes enzyme replacement therapy. The preparations are taken with food so that the body can absorb fats, proteins, and carbohydrates. After complete removal of the gland, it is also necessary to coordinate nutrition with insulin therapy and regularly monitor blood glucose levels.

Doctors at Oxford Medical recommend not following an excessively strict diet for a long time without medical indications. As recovery progresses, the diet is gradually expanded to prevent weight loss and nutrient deficiencies. If diarrhea, abdominal bloating, or worsening appetite occurs, it is necessary to inform the doctor so that nutrition and treatment can be adjusted.

The consequences of the operation depend primarily on which part of the pancreas was removed. After partial resection, the organ may produce insufficient digestive enzymes and insulin. In such cases, the patient is prescribed enzyme preparations to improve digestion and, if necessary, treatment to control blood sugar levels. If the gland has been completely removed, it is necessary to take digestive enzymes and insulin throughout life.

In addition to changes in the functioning of the digestive system, there is a risk of surgical complications after the operation. Among them are:

• internal bleeding;

• infection of the surgical wound or abdominal cavity;

• formation of a pancreatic fistula — leakage of pancreatic juice from the resection site;

• delayed gastric emptying, accompanied by nausea, vomiting, and a feeling of fullness;

• formation of blood clots and other thromboembolic complications.

At the Oxford Medical medical center, special attention is paid to reducing surgical risks. Surgical interventions are performed by doctors with many years of experience, using expert-class equipment. Thorough preoperative examination, adherence to surgical protocols, and continuous medical monitoring in the inpatient department help reduce the likelihood of complications and promptly detect possible disorders during recovery.

The cost of pancreatic surgery is determined individually after examining the patient and choosing the surgical approach.

The price is influenced by:

• the type of operation — partial or total pancreatectomy;

• the surgical approach — laparoscopic or open;

• the specific features of anesthesia and the duration of hospitalization.

You can familiarize yourself with the prices for medical services in advance here. The doctor will be able to determine the final cost of the operation based on the examination results and after drawing up an individual surgical treatment plan. To schedule a consultation with a surgeon in Kyiv, call the Oxford Medical contact center or submit a request on the website.

The information is for informational purposes only and does not replace a doctor's consultation.

Sources:

• National Cancer Institute (NCI)

• National Comprehensive Cancer Network (NCCN)

• United European Gastroenterology (UEG)