Surgical Procedures: Pancreatectomy for Pancreatic Carcinoma

What is a pancreatectomy and how is it done?

The pancreas is a gland that is shaped like a pear. The pancreas sits between the stomach and spine (back bone). There are three parts to the pancreas: the head, the body, and the tail. The pancreas makes digestive enzymes and hormones that help control blood sugar.

A pancreatectomy is the removal of part or all of the pancreas. It can be used to treat some cases of pancreatic cancer. There are two types of pancreatectomy:

• Distal Pancreatectomy: The body and tail of the pancreas are removed. The spleen is often removed also. There are two ways that a distal pancreatectomy can be done:
  • Open Distal Pancreatectomy and Splenectomy: The body and tail of the pancreas and the spleen are removed through an open incision (cut).
  • Laparoscopic Distal Pancreatectomy: The body or tail of the pancreas is removed. Laparoscopy uses small incisions that surgical tools are placed through. 
• Total Pancreatectomy: The whole pancreas, part of the stomach and small intestine, common bile duct, gallbladder, spleen, and lymph nodes are removed.

What are the risks of a pancreatectomy?

Risks and side effects may be:

• Pancreatic fistula (leakage of pancreatic juice from where the pancreas is attached to the intestine).
• Gastroparesis/gastric ileus (muscles in your stomach stop working).
• Slowed gastric emptying.
• Long-term digestive issues, like bowel habit changes, malabsorption (not absorbing the nutrients from foods you eat), need to change your diet, diabetes, and weight loss.
• Bleeding.
• Infection.

What is recovery like?

The hospital stay for a pancreatectomy is often one to three weeks. While in the hospital you may have: 

• Abdominal (belly) drains to take out extra fluid. 
• Nasogastric (NG) tube (tube placed into your nose and down into your stomach) to keep your stomach empty.
• Bladder catheter to empty urine from your bladder. 

You may also have:

• Epidural tube to give pain medications. 
• A feeding tube placed into your stomach or an intravenous line (IV) to give you nutrition. 

When you leave the hospital, you may still have some of these drains, tubes, or IV lines. You will be taught how to care for these. 

Before leaving the hospital, your medical team will talk with you about the medications you will be taking for blood clot/infection prevention and pain management. 

Your healthcare team will give you information on your diet after surgery. Digestive enzyme supplements may be needed to prevent diarrhea, help with food digestion, and control blood sugar levels. This may be for a short time or lifelong, based on your situation.

Recovery takes anywhere from 4-8 weeks. Your team will also talk with you about any activity changes you need to make while you are at home. These changes may be to:

• Walk as much as you can.
• Not drive while taking narcotic medications for pain.
• Not lift anything heavy, or pushing, twisting, bending, or pulling until cleared by your team.
• Eat small frequent meals. Take supplements and enzymes as told by your healthcare provider.
• Drink 6 to 12 cups of fluid each day to stay hydrated.
• Prevent constipation by drinking fluids and/or taking stool softeners.
• If you need insulin, take it as told.

What will I need at home?

• A thermometer to check for fever, which can be a sign of infection.
• Loose clothing.
• Incisional care supplies will likely be given to you at the hospital.

Symptoms to report to your healthcare team include:

• Fever. Your team will tell you at what temperature you should call them. 
• Chills. 
• Drainage (new or a change, foul-smelling, or creamy), swelling, separation, or redness at the incision site.
• Change in the amount of or a total stop of fluid in the drain.
• Any new or worsening pain. 
• Nausea, vomiting, diarrhea, and/or constipation.
• Being unable to eat.

How do I care for my incision?

You will be told how to care for your incision before you leave the hospital. Often, it is recommended that you:

• Wear loose clothing.
• Wash the incision very gently with soap and water, patting dry with a clean towel when finished.
• Do not tub bathe or put your incision under water. 
• Do not apply any lotions, powders, or ointments unless you are told to do so by your healthcare team.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.