Distal pancreatectomy, total pancreatectomy and vein resection in pancreatic cancer

Distal pancreatectomy & splenectomy:

A distal pancreatectomy is usually performed when a patient has a tumour in the body or tail (‘thin end’) of the pancreas.

This procedure involves having the tail (thin end) and body of your pancreas removed, leaving the head of the pancreas intact. Your surgeon will normally remove your spleen at the same time because it is located next to the tail of the pancreas.

Even though a distal pancreatectomy is less complicated than the Whipple’s procedure, it is still major surgery.  The spleen is an important part of your immune system, and if it is removed, you will be on antibiotics for the rest of your life to prevent infections.

Some specialists may opt to perform distal pancreatectomies via a laparoscopic procedure. This is not common, it only happens in a few specialist centres and generally only when the tumour is small. As it is keyhole surgery, recovery time for patients is usually faster than for open surgery.

Distal pancreatectomy BEFORE surgery
Distal Pancreatectomy (before surgery)
Copyright Pancreatic Cancer Action 2013. All rights reserved. Do not reproduce without permission from Pancreatic Cancer Action
Distal Pancreatectomy AFTER surgery
Distal Pancreatectomy (after surgery). Copyright Pancreatic Cancer Action 2013. All rights reserved. Do not reproduce without permission from Pancreatic Cancer Action

Total Pancreatectomy:

This is very major surgery and involves the removal of the whole pancreas as well as your duodenum, part of the stomach, the gallbladder, part of your bile duct, the spleen, and many of the surrounding lymph nodes. This operation is not often carried out as it has not been found to be any more effective for survival than either the Whipple’s procedure or the Pylorus Preserving Pancreatoduodenectomy (‘PPPD’) procedure.

There are some conditions for which it is used; for example, when tumours are found in more than one location in the pancreas, when tumours extend along the pancreatic duct, and some specific and rare types of pancreatic tumour including pre-cancerous IPMNs (intraductal papillary mucinous neoplasms).

Total Pancreatectomy (before):

Total Pancreatectomy
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Total pancreatectomy (after):

Total Pancreatectomy AFTER surgery
Total Pancreatectomy AFTER surgery. Copyright Pancreatic Cancer Action 2013. All rights reserved. Do not reproduce without permission from Pancreatic Cancer Action

Vein resection in pancreatic cancer surgery:

Getting a margin of clearance around a tumour when resecting it is important for prognosis.  Sometimes the only factor preventing a clear resection margin is how close the tumour is to the major veins near the head of the pancreas (such as the superior mesenteric vein and portal vein).

If it is thought that the surgery to remove a section of vein will make a difference to the resection margin, then surgery is considered where sections of the vein involved are removed then joined together again using a graft from another part of the body.

Vein resection is only carried out in cases where involvement is small, the surgeon is able to predict a good outcome from resection and doctors are confident of clear resection margins (i.e. the surgeon thinks this procedure will benefit the patient).

Location of pancreas in relation to the major blood vessels
Location of pancreas in relation to the major blood vessels
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Information Product No. PCA0012 v1 pgs 10 - 15 | Published: 25/01/2013 | Last Updated: 15/04/2015 | Next Review Due: 25/01/2016