PANCREATIC SURGERY

Pancreatic surgery typically involves pancreatic resections, usually for malignant tumors. Ductal adenocarcinoma is the most common and dangerous type of tumor, but if diagnosed early, it can be operated on with good chances of recovery. The prognosis is better for other types of pancreatic tumors, such as neuroendocrine or cystic tumors. For patients with advanced malignant tumors, it may be important to combine surgery with chemotherapy and/or radiotherapy before and/or after the procedure.

Pancreatic resections include pancreaticoduodenectomy (Whipple procedure) and resection of the body and tail of the pancreas. Central pancreatectomies are less commonly indicated.

The Whipple procedure is one of the most complex surgeries in general surgery. It involves removing the right side (head) of the pancreas. Since the pancreas is anatomically linked to intestinal (duodenum) and biliary (common bile duct) structures, the resection is lengthy and complex, as is the reconstruction phase. Therefore, this surgery can present some serious postoperative complications, making it essential that an experienced surgeon performs it in a facility with expertise in diagnostic imaging, interventional radiology, and operative endoscopy. The Whipple procedure is also the preferred option for malignant tumors of the duodenum and distal bile duct (the part of the bile duct located within the pancreas).

A resection of the body and tail of the pancreas may be accompanied by the removal of the spleen for technical or oncologic radicality reasons.

Tumors affecting the main pancreatic duct may lead to a total pancreatectomy.

Pancreatic resections may also be indicated for some benign or low-grade malignancies. Less aggressive procedures, such as enucleations or partial resections, are available for these conditions.

All of these procedures can be performed via open surgery or using minimally invasive techniques (robotic or laparoscopic surgery). The pathology for which surgery is indicated, the location, the patient’s concurrent conditions, and their physical characteristics will help determine the type of surgical approach.