- Michael D Kluger, MD, MPH
Michael D Kluger, MD, MPH
- Assistant Professor of Surgery
- College of Physicians and Surgeons
- New York-Presbyterian Hospital/CUMC
- James Lee, MD
James Lee, MD
- Edwin C. and Anne K. Weiskopf Associate Professor of Surgical Oncology (in Surgery and in the Herbert Irving Comprehensive Cancer Center)
- Columbia University Medical Center
- John Chabot, MD
John Chabot, MD
- David V. Habif Professor of Surgery
- Columbia University Medical Center
- Section Editors
- Sally E Carty, MD, FACS
Sally E Carty, MD, FACS
- Section Editor — Endocrine Surgery
- Professor, Chief, Division of Endocrine Surgery
- University of Pittsburgh School of Medicine
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
The pancreas has exocrine and endocrine functions that are essential to life. A loss of such functions can result from either disease (eg, chronic pancreatitis, cystic fibrosis) or surgery (total pancreatectomy). The development of long-acting insulin and effective digestive enzymes have made it possible for patients to sustain a reasonable quality of life after a total pancreatectomy.
Total pancreatectomy has been performed since the 1970s, and its frequency has increased over the last two decades. The anatomy of the pancreas makes it difficult to remove. Along its length, the pancreas contacts almost all structures of the upper abdomen, and the head of the pancreas is densely adherent to the duodenum and envelops the distal common bile duct. As a result, a total pancreatectomy most often requires a concomitant duodenectomy, and subsequent gastric and biliary anastomoses to the jejunum to preserve gastrointestinal continuity.
The indications for and techniques of total pancreatectomy are discussed in this topic. Techniques of partial pancreatic resection are discussed in other topics. (See "Surgical resection of lesions of the head of the pancreas" and "Surgical resection of lesions of the body and tail of the pancreas".)
INDICATIONS FOR TOTAL PANCREATECTOMY
Total pancreatectomy is a major operation with potential for mortality and severe morbidity. It is reserved for patients who have failed medical management and are not candidates for less extensive surgery. The indications for total pancreatectomy:
●Severe benign or intractable conditions that cannot be effectively treated medically or with less extensive resection:
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- INDICATIONS FOR TOTAL PANCREATECTOMY
- Planned total pancreatectomy
- - Chronic pancreatitis
- - Hereditary pancreatitis
- - Intraductal papillary mucinous neoplasm
- - Pancreatic cancer
- - Pancreatic neuroendocrine tumor
- - Pancreatic metastasis of renal cell cancer
- Conversion total pancreatectomy
- Completion (rescue) pancreatectomy
- PREOPERATIVE PREPARATION
- Patient screening
- Imaging studies
- INTRAOPERATIVE MANAGEMENT AND TECHNIQUES
- Standard technique
- - Incision
- - Pancreatectomy
- - Reconstruction
- - Islet cell transplantation
- Other techniques
- POSTOPERATIVE MANAGEMENT
- Endocrine replacement
- - After islet autotransplantation
- Exocrine replacement
- MORBIDITY AND MORTALITY
- - Complications of diabetes
- - Malnutrition
- - Quality of life
- SUMMARY AND RECOMMENDATIONS