Pancreatectomy (pancreas removal)

Pancreatectomy is the surgical removal of all or part of the pancreas. It’s often done to treat pancreatic and other types of cancer, but doctors may also use it to treat severe chronic pancreatitis and other conditions that affect the pancreas and nearby organs, including benign tumors and cysts.

If you’re facing a cancer diagnosis, a pancreatectomy may be recommended, either alone or combined with chemotherapy and radiation. If you have a noncancerous pancreatic cyst, pancreas removal surgery can help relieve symptoms and improve your quality of life.

Penn Medicine surgeons perform a high volume of pancreas removal surgeries each year and are among the most experienced in their field, regularly performing all types of pancreatectomies, including the highly complex Whipple procedure. We offer the latest and most advanced surgical techniques, including minimally invasive laparoscopic and robotic pancreatectomy. 

The pancreas is shaped like a fish and has what looks like a head, body, and tail. Your doctor will recommend what type of pancreatectomy is best for you based on your diagnosis, how much of the organ must be removed, and where your tumor is located. 

• Distal pancreatectomy: Distal pancreatectomy is the removal of the body (middle) and tail (end) of the pancreas and usually the spleen. It’s performed for tumors that develop on the left side of the pancreas.  
• Total pancreatectomy: A total pancreatectomy involves removing the entire pancreas, spleen, gallbladder, part of the bile duct, and some of the small intestine. In some cases, part of the stomach may be removed as well. It is more often used to treat non-cancerous conditions that could later turn into cancer.  
• Total pancreatectomy with auto islet cell transplantation (TPIAT): Used to treat severe chronic pancreatitis, TPIAT allows surgeons to save any healthy endocrine cells (or islets) in the pancreas at the same time they remove the pancreas. These islets are then placed back in the liver to produce insulin that can prevent or minimize diabetes, which can be a side effect of pancreas removal. 
• Pancreatoduodenectomy: Also known as the Whipple procedure, pancreatoduodenectomy is the removal of the head of the pancreas, along with the part of the small intestine that connects to it (duodenum). The Whipple procedure concludes by reattaching the remaining pancreas, bile duct, and stomach to the remaining small intestine so that digestion can continue normally. 
• Enucleation: While most pancreatic tumors are adenocarcinomas, some are neuroendocrine tumors (NETs), a rare type of tumor that develops in the cells of the neuroendocrine system. To treat NETs, we may perform a procedure called enucleation, in which your surgeon removes just the tumor, leaving your pancreas intact.

Your doctor may recommend removal of the pancreas to remove cancerous tumors, relieve symptoms caused by benign cysts, or help stabilize pancreatic function. Conditions that may be treated by pancreatectomy include: 

• Pancreatic cancer
• Pancreatitis
• Bile duct cancer
• Duodenal (small intestine) cancer
• Gastrointestinal stromal tumors
• Metastatic kidney cancer
• Neuroendocrine tumors (NETs)

Your care team will start by determining if you’re a candidate for pancreas removal based on your symptoms, test results, and the size and location of your tumor. If the tumor is too big to safely remove or contains critical blood vessels, you may also receive chemotherapy to try to shrink it. Your care team will discuss any testing or other steps you should take before your procedure. Your doctor will thoroughly explain what will happen during your surgery to make sure you’re comfortable and informed before going through the procedure.

On the day of your surgery, an anesthesiologist will administer anesthesia through an IV to keep you asleep and comfortable during your procedure. You will be continuously monitored by our experienced operating room practitioners.

Most pancreatectomy procedures are done through open surgery. During this type of procedure, your surgeon will make one long incision in your abdomen to access your pancreas and other organs. However, some surgeons use minimally invasive techniques such as laparoscopic and robotic surgery (called a robotic prostatectomy) that use smaller incisions. For these techniques, multiple smaller incisions are made using long tools or robotic arms, and a camera can be inserted to perform the surgery.

Surgery can last anywhere from two to six hours, depending on what type of pancreatectomy is being performed. Once complete, the surgeon will close your incisions and you will be transported to a recovery area to be monitored as you wake up from the anesthesia.

After your pancreatectomy surgery you will be kept in the hospital for observation and recovery. Most people can expect to spend at least a week in the hospital while they recover from pancreas removal surgery. 

It takes about three months to fully recover from pancreatic surgery. Because weight loss may occur during this healing time, our providers and registered dietitians are here to monitor and support you throughout your recovery.  

You will follow up with your Penn Medicine care team for a year or more to ensure you get the additional care you may need, including treatment and support from specialists in our Endocrinology, Diabetes, and Metabolism program. 

Like any surgery, pancreatectomy comes with a certain amount of short and long-term risk including:

• Infection 
• Bleeding and leaking 
• Digestive problems 
• Weight loss 
• Changes in bowel movements

Many patients who undergo pancreatectomy may also develop diabetes because of the role of the pancreas in regulating blood sugar. If this is the case for you, your doctor will work with you to help you develop a plan to manage it.