Pancreas are a small, but a pretty important part of a person s digestive system. So when it needs to be removed, the reason has got to be quite serious, to say the least, doesn t it? The procedure is known formally as a pancreatectomy and it is most often required for people who are suffering from cancer of the pancreas. Ideally, these people would only need the cancerous tumours removed, but things are not always this simple. As a matter of fact, only a little more than a tenth of the people who have pancreatic cancer can have the tumour alone removed. As a result, most need to go for a pancreatectomy, which involves removing the entire pancreas. Whether the pancreas can be kept is usually related to how soon the cancer was detected, with people who have done so in time being a majority of the 10% of people with pancreatic cancer who have not needed pancreatectomies.

If a person does not have cancer, the reason he or she may need a pancreatectomy due to an accident which has injured the area significantly badly. In this case, a procedure which is known as a partial pancreatectomy is carried out on the patient. The good news is that the success rate of this sort of operation is generally quite high and the long-term effects on the body are nil. This is the case in spite of a lot of the normal tissue of the pancreas being removed, pretty amazing, isn t it?

While it may be called a pancreatectomy, it does not always mean that the pancreas is the only thing that is removed. In fact, in a lot of pancreatectomies, the surgeons also remove other parts of the digestive system which are usually the common bile duct, the spleen and the gallbladder.

There is, of course, the case of chronic pancreatitis, which occurs when the organ just swells up repeatedly. The repeated swelling leads to permanent damage of it, which affects the rest of the body, too. In most cases, the cause of this happens to be a sustained addiction to alcohol. When this is the case, it is really hard to perform a pancreatectomy and the utility of the pancreas is greatly reduced. Not a good situation to be in, under any circumstances, at all!

A pancreatectomy is a process which nobody would voluntarily wish to undergo, but there are advantages to knowing what it is, in any case!

Pancreatectomy - When To Go For It?

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

Pancreas is a small organ that is located in the lower part of the stomach. It lies just behind the abdomen. It functions by producing the insulin hormone which is responsible for regulating blood sugar level in the body and breaking down food into glucagon which is stored in the body. This glucagon is converted into glucose which is used by the body for energy and other purposes. Therefore, pancreatic transplant is done in patients with a malfunctioning pancreas.

Why is pancreatic transplant required?
Patients suffering from type I diabetes usually undergo a pancreatic transplant. Type I diabetes is characterized by the inability of the pancreas to produce insulin, thereby leading to low blood sugar level. This type of diabetes occurs due to the malfunction of pancreatic beta cells whose primary role is to produce insulin. These beta cells make up around 65 to 80 percent of the cells found in the pancreatic islets. They typically malfunction when the body's immune system begins to attack and destroy the pancreatic beta cells. Therefore, type I diabetes is an autoimmune disorder. Patients with type I diabetes require insulin injections that might cause severe reactions. People dependent on insulin are prone to the development of diabetic retinopathy and diabetic nephropathy.

People with type II diabetes generally do not need pancreatic transplant because this type of diabetes occurs due to low production of insulin or lack of insulin resistance. Here is a list of the probable reasons why pancreatic transplant is required:

People who have type I diabetes but are not cured by standard treatment
Severe reactions to insulin injections
Low blood sugar
Kidney damage
Hypoglycemia unawareness
A pancreatic transplant can be of three types. They are:

Pancreas transplant only- People with type I diabetes and normally functioning kidneys require only a pancreatic transplant.
Pancreas and kidney transplant- Type I diabetes, in rare cases, leads to end-stage renal disease (ESRD) or end-stage kidney disease where one or both the kidneys are damaged. In such cases, pancreas and kidney are transplanted simultaneously to disable the dependence on insulin injection. This type of surgery may also be required when the pancreas and the kidneys come from the same donor.
Pancreas-after-kidney transplant- In some cases of type I diabetes, your doctor will recommend kidney transplant first followed by pancreatic transplant. It must be remembered that pancreatic transplant should be done by taking into consideration the side-effects caused by the anti-rejection injections administered after the procedure is performed. It may cause bone thinning, high cholesterol and high blood pressure in a patient s body. As the anti-rejection injections work by suppressing the immune system, the body s defense mechanism against infections and other diseases becomes ineffective to a considerable extent.
A pancreatic transplant is a serious procedure that requires a lot of deliberations and consultations with your doctor and should only be opted for when the benefits outweigh the side effects from the anti-rejection medications.

Pancreatic Transplant - When Is It Required?

The pancreas is a gland located in the abdominal region that performs two main functions for the body: produces digestive juices and the hormone insulin which regulates the blood sugar levels. The part which produces the digestive juices is exocrine and the insulin-producing part is the endocrine portion. Pancreatic cancer, which is an uncontrolled growth of the pancreas cells, often starts in the exocrine portion and is known as the pancreatic adenocarcinoma. The one which develops in the endocrine portion is known as neuroendocrine cancer or islet cell tumors.

Risk factors
Though not clearly established, the following factors are believed to up the risk of pancreatic cancer.

Smoking
Family history
Prolonged uncontrolled diabetes
Pancreatic conditions like inherited pancreatitis
Chronic inflammation of the pancreas
Symptoms
A pancreatic condition is of insidious onset, and the exact period of onset cannot be determined. The symptoms also are nonspecific abdominal symptoms, which do not pinpoint the pancreas per se.

Jaundice, which includes yellowing of the skin and whites of the white. This is because the growth of the pancreas puts pressure on the liver and bile ducts, and so hampers bile flow.
Weight loss, which was unintended. This is due to a bloated feeling plus inability to digest the foods.
Severe pain, which can be difficult and may even require regular injections to control.
Fluctuating sugar levels, which is unexplained.
Onset of diabetes, which is associated with weight loss and jaundice.
Increased tendency for blood clots.
Loss of appetite.
Bowel obstruction due to blockage of the growing pancreas.
Diagnosis
The above symptoms could lead to a further investigation that includes a few important tests, like the following.

Blood tests
Insulin levels
CT scan
Ultrasound
MRI
Laparoscopy, both to look for the extent of the disease and to do a biopsy, which can be used for confirming the type of cancer
Percutaneous transhepatic cholangiography: A dye is injected into the pancreas to study the spread of the dye, which will also help identify the diseased portion.
Treatment
Pancreatic cancer is very aggressive, usually not detected early, and has a very poor prognosis. So, if there is a family history or one has a prolonged pancreatic condition, it is advisable to go for annual screening to help with early detection and intervention. Once identified, treatment would include a combination of the three modalities   surgery, radiation, and chemotherapy. Surgery often may be followed by chemotherapy and/or radiation.

Prognosis
The prognosis for pancreatic cancer is very poor. Only about 25% of patients diagnosed with pancreatic cancer live past the first year. Early detection of risk factor remains the best way to improve prognosis. In case you have a concern or query you can always consult an expert & get answers to your questions!

Pancreatic Cancer - 8 Common Signs You Must Be Aware Of!

Chronic pancreatitis refers to an inflammation of the pancreas   the organ that creates enzymes and hormones to manage blood sugar levels and aids in digestion. The condition either does not heal completely and keeps coming back, or persists for months or years at a stretch.

Chronic pancreatitis is a serious, debilitating condition, which can potentially lead to permanent damage and scarring of the organ. The following are the consequences-

  Formation of cysts and calcium stones in the pancreas
  Blockage of the gastrointestinal tract
  Malnutrition
  Diabetes

The condition is most likely to develop between the ages of 30 and 40 and is commonly observed in men than in women.

Causes of Chronic Pancreatitis:

A number of factors are responsible for long-term pancreatitis. The most common ones include-

  Alcohol abuse   Reportedly, 70% of all cases regarding the condition is related to alcohol consumption
  Autoimmune diseases   When your body attacks the healthy tissues and cells mistakenly
  Genetics
  A constrict pancreatic duct   The tube that carries enzymes to the small intestine from the pancreas
  A blockage of the pancreatic duct by stones
  Cystic fibrosis   A hereditary disorder that causes mucus to build up in the lungs
  Hypercalcemia   When the level of calcium in the bloodstream increases abnormally
  Hypertriglyceridemia   When the level of triglycerides in the blood rises up

Warning Signs of Chronic Pancreatitis:

Symptoms of chronic pancreatitis do not show up at the early stages. They become more evident when inflammation aggravates. However, you should look out for the following signs-

  Severe abdominal pain   Usually in the upper portion
  Loose stool that appears pale and does not flush away easily
  Vomiting and nausea
  Unintentional weight loss
  Fatigue
  Excessive thirst
  Shortness of breath
  Diarrhoea
  Jaundice
  Pancreatic fluids inside the stomach
  Intestinal blockage
  Internal bleeding

The above symptoms vary based on the severity of the condition. Painful episodes may last for days. For some people, drinking and eating seem difficult because that makes the pain worse. With the progression of persistent pancreatitis, the pain becomes constant. Seeking treatment at the earliest is necessary for the condition to heal.

Diagnosis and Treatment:

A blood test alone is not sufficient to detect the changes in your pancreas in the initial stages. An imaging test is the most reliable method to confirm the diagnosis. Your doctor may recommend the following tools-

  CT Scan
  X-ray
  Ultrasound
  MRI Scan

The objective of the treatment is to reduce pain and improve the functioning of your digestive system. The damage to the pancreas cannot be cured, but your doctor will prescribe necessary measures to manage the symptoms of the condition.

The primary treatment methods include endoscopic therapy, medications, and surgery.

  Medication - Pain killers, insulin steroids, and artificial digestive enzymes may be taken as per the doctor s recommendation
  Endoscopy - The procedure involves inserting a flexible, long tube (known as an endoscope) through the mouth. It allows the doctor to look at the pancreatic stones formed inside. He/she then removes the stones, places stents to improve the flow, and seals the leakage.
  Surgery - The last resort is surgery. The doctor will recommend it only if medications and endoscopy therapy have failed to rectify the painful symptoms. Removing a portion of the diseased pancreas can offer relief. Surgery may also be performed to drain cysts and to unblock or widen the pancreatic duct.

The outlook depends on the underlying causes and the seriousness of the disease. However, immediate treatment and diagnosis can improve the outlook. Consult a doctor as soon as you encounter the above symptoms of pancreatitis.

Chronic Pancreatitis - Everything You Should Be Knowing!

The diagnosis as well as management of pancreatic cystic lesions is a general problem. Nearly 1% of the patients in the chief medical centers have been observed to have pancreatic cystic lesions on cross sectional imaging. It has also been observed that a quarter of all pancreas scanned in an autopsy series contain pancreatic cysts. Earlier, these cystic lesions were regarded benign but with increasing evidence made available from the cystic lesions, they are regarded as origin of pancreatic malignancies.


Information on asymptomatic neoplastic pancreatic cysts
The most vital medical tools that are used in the diagnosis and management of pancreatic cystic lesions include the endoscopic ultrasound and cross sectional imaging. These are used to distinguish non-mucinous cysts from mucinous cysts. The identification of pancreatic cysts creates a lot of anxiety for the clinicians as well as the patients related to the probable presence of a fatal tumor. The findings of a macro cystic lesion that enclose viscous fluid loaded in cea are helpful in the analysis of a mucinous lesion. 


The most common pancreatic cysts are the non-neoplastic inflammatory pseudo cysts, and they can be detected easily by imaging. The identification of pancreatic irregularity with probable association with malignant cells is a vital source of referral for the specialist. The set of guidelines that have been proposed for the management and diagnosis of patients with asymptomatic neoplastic pancreatic cysts are based specifically on the analysis of the quality of the data. It is also designed to address the most important and frequent clinical scenarios. The diagnostic suggestions are provided based on the clinical problem as well as the risk of malignancy.


Imperative guidelines to follow
To achieve accurate diagnosis of asymptomatic neoplastic pancreatic cysts is indeed a great challenge. It is all the more important to find the reproducible methods that can be used to stratify threat of cancer for the patients. The main guidelines include a two year screening interval of cysts that can be of any size as well as stopping observation after 5 years, in case there is no change. The new guidelines, for the most part, recommend surgery if more than one concerning feature is confirmed on the mri by use of endoscopic ultrasound. The new guidelines even suggest discontinuation of inspection after the surgery if no dysplasia or invasive cancer is identified. The guidelines have mainly been developed by use of grading of recomendations assessment, development and evaluation.

Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

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