Dr. Kolachalam, Pancreatic Surgery
What & Where is the Pancreas?
The pancreas is an oblong flattened gland located deep in the abdomen. It is sandwiched between the stomach and the spine. It lies partially behind the stomach and partially nestled in the curve of the small intestine. Most people don’t know as much about the pancreas as they do about other parts of their bodies. In fact, this gland is an integral part of the digestive system that often goes unnoticed until problems occur. If you are concerned about pancreas cancer, you will want a lot more information.
Because of the pancreas’ deep location, tumors are rarely palpable (able to be felt by pressing on the abdomen.) It also explains why many symptoms of pancreatic cancer often do not appear until the tumor grows large enough to interfere with the function of nearby structures such as the stomach, duodenum, liver, or gallbladder.
What does the Pancreas do?
The pancreas produces (in addition to others) two important hormones, insulin and glucagon. They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuel to produce and maintain stores of energy.
Why do you need surgery?
- Pancreatic Pseudocysts
- Pancreatic Cysts
- Solid Tumors
- Chronic Pancreatitis
Surgery is the only known cure for pancreatic cancer and is the standard of care. Surgery is only possible if the cancer is localized. If cancer has spread to blood vessels, distant lymph nodes, or other organs, then surgery is usually not indicated.
What procedures are common of the Panceras?
Distal Pancreatectomy (Open or Laparoscopic)
A distal pancreatectomy is indicated to remove tumors in the body and tail of the pancreas. The procedure can be done as open surgery as well as laparoscopically. We often remove the spleen at the same time. If the spleen is going to be removed, it will be necessary for you to receive vaccinations from your primary care provider prior to surgery.
These vaccinations include: Pneumococcal vaccine, Meningococccal vaccine, and H. Influenzae type B (these can be given 14 days prior to surgery or 14 days after surgery).
Pancreaticoduodenectomy is the operation performed for neoplasms that are in the head of the pancreas, the duodenum, or the lower part of the common bile duct. It is commonly referred to as the “Whipple procedure”. The Whipple procedure involves removal of the head of the pancreas, the duodenum, a portion of the common bile duct, the gallbladder, many lymph nodes and a small portion of the stomach. The pancreas, stomach and the remaining part of the bile duct are then reconnected to a part of the small intestine called the jejunum to ensure flow of bile and enzymes into the intestines.
Total pancreatectomy is similar to the Whipple procedure except that the entire pancreas is removed. Removal of the entire pancreas can cause pancreatic insufficiency, which can lead to difficulty processing food by the body and inadequate insulin secretion. These can be treated with pancreatic enzyme replacement and insulin injections.
Palliative surgery is often done when the tumor is unable to be surgically removed due to invasion into other organs and/or blood vessels. In these cases, other surgical procedures, such as bypass or stent placement, may be done to improve quality of life and relieve symptoms such as jaundice, nausea, vomiting and pain. Your surgeon may also place a feeding tube to help with nutrition.
Additional treatments such as radiation and chemotherapy may be indicated and will be further discussed with your oncologist.
What is pancreatic cancer?
Pancreatic cancer is the fourth leading cause of cancer deaths. Signs and symptoms can include:
- abdominal pain
- decreased appetite
- unintentional weight loss
- itching of the skin
- jaundice or yellowing of the skin and/or eyes
- discoloration of stool and urine.
What do I need to do before surgery? (See check list)
Prior to surgery you will need to see your primary care physician and/or your cardiologist to get appropriate medical/cardiac clearance. You may need additional testing to prepare you for surgery.
You will also need to call the Pre-Surgical Testing (PST) department to make an appointment. They may draw your blood and will ensure that all necessary information is completed prior to your surgery.
You should take a multivitamin daily. This can be purchased over-the-counter (OTC) at your local drug store.
You will need to stop taking all blood thinners such as aspirin,Coumadin, and Plavix seven to ten (7-10) days prior to your surgery.
Please discuss this with your primary care physician and/or your cardiologist before stopping any medications.
What to expect the day of your surgery?
- Surgery may take four to six hours. Most patients will be in the hospital for approximately 9-10 days.
- Pain is controlled with intravenous (IV) pain medications, although other options, such as an epidural, are also occasionally used.
- Surgical drains may be placed in the abdomen while you are in surgery; most often they are removed prior to going home. In some cases, however, it is necessary for you to go home with a drain in place.
- You will be assisted and encouraged to walk the hallways at least four to six times a day.
- Nutrition may be supplied intravenously until you are able to eat.
- Usually you are able to have ice chips the day after surgery and will be on a clear liquid diet within three to four days after surgery.
You will be ready to go home:
- When your pain is controlled with an oral pain medication
- When bowel function has returned
- When you are able to eat without nausea
- When you are without fever, or other signs of infection
What to expect at home:
- When you go home you will be able to shower, eat and climb stairs.
- No heavy lifting over five pounds.
- No driving until seen by the surgeon in follow-up.
- Expect to be off work for six to eight weeks.
- It is common to feel tired and weak the first several weeks.
- It can take approximately eight weeks to return to your baseline functional status.
How to take care of your incision:
You may shower and cleanse your incision with mild soap and water daily, patting it dry.
- No bath tubs or hot tubs.
- Do not apply any lotions, perfumes, or colognes to incision.
- Staples will be removed in the doctor’s office.
- Look at your incision daily and notify Dr. Kolachalam if there are any signs of infection, such as temperature of 101°F, foul odor or drainage from wound, redness, or swelling.
- Notify Dr. Kolachalam if you have nausea, vomiting, lack of bowel movement or inability to eat.