Pancreatic Resection
Pancreatectomy is surgery to remove part or all of your pancreas. It is usually done to treat cancer, and sometimes, for benign conditions such as large cyst (>3cm), pancreatic stone and chronic pancreatitis. Removing part or all of your pancreas can have lifelong consequences for your digestive system. You may need to take insulin and digestive enzymes thereafter.
Liver cancers can be primary (arising from liver) or metastatic (spread from other cancers e.g colorectal cancer, neuro-endocrine tumours etc). The primary liver cancers could arise from liver parenchyma (hepatocellular carcinoma) or from biliary tract within the liver (cholangiocarcinoma). In Australia, the commonest indications for the liver surgery is colorectal metastasis.
The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.
The liver consists of two main lobes – right and left. Both are divided into eight functional segments of lobules based on the distribution of blood supply and biliary drainage. The left liver is comprised of segments II, III, and IV, while the right liver is comprised of segments V, VI, VII, and VIII. Segment I is the caudate lobe. These lobules are connected to small ducts (tubes) that connect with larger ducts to form the common hepatic duct. The common hepatic duct transports the bile made by the liver cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile duct.
Pancreas – the organ
The pancreas is an elongated, tapered organ located across the back of the belly, behind the stomach. The right side of the organ—called the head—is the widest part of the organ and lies in the curve of the duodenum, the first division of the small intestine. The tapered left side extends slightly upward—called the body of the pancreas—and ends near the spleen—called the tail.
The pancreas is made up of 2 types of glands:
Exocrine. The exocrine gland secretes digestive enzymes. These enzymes are secreted into a network of ducts that join the main pancreatic duct. This runs the length of the pancreas.
Endocrine. The endocrine gland, which consists of the islets of Langerhans, secretes hormones into the bloodstream.
What happens when you are diagnosed with pancreatic cancer?
We understand this could be a very stressful time of your life. We could make the journey smoother for you by organising the appropriate work-up in the timeliest manner. You will require blood test, which includes tumour makers. You will also need further imaging in the form of CT pancreas, MRI or FDG PET.
Occasionally, you will require an endoscopic retrograde pancreaticography (ERCP) and stenting if your bile duct is blocked by the cancer. ERCP also allows us to biopsy the lesions if it is necessary.
Once the workup is complete, your case will be discussed in a multi-disciplinary meeting which includes your surgeon, medical oncologist, radiation oncologist, and interventional radiologist to discuss the specific type of treatments and treatment sequence.
What are the different types of pancreatectomy surgery?
Distal pancreatectomy. The distal part of your pancreas is the body and tail (“distal” means distant, or the farthest part from the center). A distal pancreatectomy removes the tail of your pancreas, and sometimes the body if that’s involved, too. The tail of your pancreas is closely connected to your spleen. A distal pancreatectomy often involves removing your spleen along with the tail of your pancreas. This is performed laparoscopically.
