Pancreatectomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Pancreatectomy is surgical removal of part or all of the pancreas. A Whipple procedure (pancreaticoduodenectomy) removes the pancreatic head, duodenum, bile duct, and gallbladder. Distal pancreatectomy removes the body and tail. Total pancreatectomy removes the entire gland, causing permanent diabetes.

Indications include pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumours, intraductal papillary mucinous neoplasm (IPMN), chronic pancreatitis with intractable pain, solid pseudopapillary tumour, and pancreatic trauma. Resectability requires the absence of major vascular invasion.

Whipple surgery proceeds via open or minimally invasive (laparoscopic/robotic) approach. After resection, three anastomoses reconnect: pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy. Distal pancreatectomy often includes splenectomy. High-volume centres perform over 20 resections annually with significantly better outcomes.

Enhanced recovery after surgery (ERAS) protocols allow diet introduction by day 3–5. Most patients are discharged in 7–10 days. Pancreatic enzyme replacement therapy (PERT) is required for exocrine insufficiency. Diabetes management begins immediately after total pancreatectomy.

The Whipple carries 3–5% mortality at high-volume centres (up to 15% at low-volume hospitals). Major complications include delayed gastric emptying (20–30%), post-operative pancreatic fistula (10–20%), bile leak, wound infection, and haemorrhage. Volume-outcome relationship is strong.

R0 (clear margin) resection is the primary oncological goal. For resectable pancreatic cancer, median survival is 20–24 months with adjuvant chemotherapy; 5-year survival is 15–25%. Pancreatic neuroendocrine tumours have far better prognosis, with 5-year survival over 60% after complete resection.