The body and tail of the pancreas are removed during a distal pancreatectomy. The end of the pancreas is then over-sewn or stapled closed and the pancreatic fluid drains normally into the duodenum. Depending on the location of the tumor, its relationship to the major vascular structures, the type of tumor and the body habitus of the patient, this can be achieved using three different approaches.
The traditional approach is performed through a abdominal incision, usually under the ribs on the left side. This approach is usually needed for large malignant tumors or those that involve the local blood vessels.
Smaller, less aggressive and more distal tumors in the tail of the pancreas are often amenable to a minimally invasive approach (either laparoscopic or robot-assisted). In approach, the procedure is performed through 4 smaller port sites, one of which needs to be extended for extraction of the specimen. The minimally invasive approach offers patients less pain, a smaller scar, and a quicker recovery. This approach is employed when it is safe and feasible without compromising the oncologic outcome for the patient.
About 10% of the time a minimally invasive procedure needs to be converted to a traditional open approach for the safety of the patient.
The blood supply to the spleen runs through the back of the tail of the pancreas. If the tumor is involving these vessels, then the vessels with the spleen will also need to be removed during the distal pancreatectomy. If the blood supply to the spleen is not compromised by the tumor, then the spleen can often be preserved.
The spleen is a large lymph node that is important in education of a child’s immune system. In adulthood, the spleen only protects us from three specific bacteria (Pneumococcus, Neisseria meningitidis, and Haemophilus influenzae) all of which can be prevented with vaccines. Patients that have their spleens removed will need to be vaccinated against these organisms every 5 years.
Risks and Considerations
A distal pancreatectomy takes about 3 hours to complete. There is a risk of bleeding after the surgery, requiring and return to the operating room. Minor infections can also occur.
The most common complication following the procedure is leaking of pancreatic juice out of the back of the gland. This is usually not a dangerous complication, because the pancreatic enzymes are not activated. But the fluid does tend to collect behind the stomach causing local inflammation and making it difficult to eat. Many times these fluid collections will resolve on their own, but in some cases, a temporary drain will need to be placed either by a radiologist or a biliary endoscopist to clear the collection and improve symptoms