Pancreatectomy for neuroendocrine tumors

This page was reviewed under our medical and editorial policy by

Chukwuemeka Obiora, MD, Surgical Oncologist

This page was reviewed on March 17, 2023.

The pancreas is an organ located next to the spleen and behind the stomach. It contains exocrine cells responsible for releasing enzymes that help digest food (particularly fats), as well as endocrine cells that release the blood sugar-controlling hormones insulin and glucagon.

If cancer develops in the exocrine cells, it’s called adenocarcinoma of the pancreas. When it starts in the endocrine cells, the cancer is known as a pancreatic neuroendocrine tumor (NET). According to the American Cancer Society (ACS), fewer than 2 percent of all pancreatic cancers are pancreatic NETs, also called islet cell tumors.

This article will cover:

What is a pancreatectomy?

A pancreatectomy is a surgical procedure to remove all or part of the pancreas. In some cases, the spleen and other organs may also be removed.

Most often, treatment for NETs involves a pancreatectomy, which is a type of pancreatic cancer surgery that may be used either to completely remove the cancer or as a palliative option to reduce symptoms.

Pancreatectomies may be partial or total, depending on the size, location and type of NET. Because it’s a complex surgery that may result in complications and typically has a long and difficult recovery time, it’s important to discuss the risks and benefits with the care team.

This surgery also may be used to treat pancreatic adenocarcinomas.

Pancreas removal types

The specific type of pancreatectomy used to treat a patient's pancreatic cancer or NET is based on the grade and location of the tumor.

A staging laparoscopy may first be performed to determine how far the tumor has progressed and whether or not surgery to remove it is possible. A surgeon makes several small “keyhole” incisions on the abdomen and uses a laparoscope, a thin instrument with a camera on one end, to view the patient's pancreas and possibly take a biopsy.

In the past, a pancreatectomy was performed exclusively via traditional surgery with a large abdominal incision (open surgery), but the past 10 years have presented medical advances. Pancreatectomies are now also performed laparoscopically (with tiny incisions) and/or with the use of robotic arms that help guide the surgery—both are more advanced and less invasive procedures.

Using these methods helps to speed up recovery time and reduce potential complications. A laparoscopic pancreatectomy may be used to perform all types of pancreatectomies, but only the surgeon determines whether open or laparoscopic surgery is appropriate based on the extent of the cancer.

If the tumor is resectable (removable), the patient may undergo one of the following procedures, either laparoscopically or via open surgery.

Central pancreatectomy

This procedure removes the neck and part of the body of the pancreas but leaves the head and tail. It’s typically performed for tumors in the neck of the pancreas.

After this surgery, the pancreas continues to function. However, it's not appropriate for all cancer types. It may offer good results in patients with benign or low-grade tumors.

Distal pancreatectomy

During a distal pancreatectomy, a surgeon removes the tail alone, or the tail and a portion of the body of the pancreas, often along with the spleen. Because it’s a partial pancreatectomy, the pancreas may still produce its own enzymes.

However, cancers in the body and tail are often diagnosed after they’ve spread, which means this surgery may not be appropriate. If the patient has his or her spleen removed during a distal pancreatectomy, the body has an increased risk of infection, so extra precautions are needed.

Whipple procedure

In a Whipple procedure (also called a pancreaticoduodenectomy), the pancreas' head and sometimes part of the body are removed, along with:

  • Lymph nodes
  • A portion of stomach and small intestines
  • Part of bile duct
  • The gallbladder

When part of the stomach is removed, sections of the bile duct and pancreas remain attached to the small intestine, so that bile and digestive enzymes are able to pass through.

This is the most common surgery for cancer in the head of the pancreas. However, it’s a complex procedure with a risk of complications, including infection, bleeding and diabetes, which is why it’s critical to choose a skilled surgeon for the procedure.

Total pancreatectomy

Similar to a Whipple procedure, a total pancreatectomy involves the removal of:

  • The entire pancreas
  • Some of the stomach and small intestine
  • Bile duct
  • Gallbladder
  • Spleen
  • Lymph nodes

This surgery can be appropriate in cases where the cancer has spread through the entire pancreas. However, removing the pancreas can also have major side effects and complications, so a total pancreatectomy isn’t performed often.

Can people live without a pancreas?

It is possible to live without a pancreas, but the patient must take extra steps to maintain his or her health. These include:

In addition, patients who don’t have a pancreas develop diabetes, so they should speak with the care team about how this affect his or her lifestyle.

How to prepare for a pancreatectomy

Before a pancreatectomy, the patient will likely undergo a laparoscopy to determine the location and extent of the tumor. Even so, the surgeon won’t always know whether the tumor is resectable until during the procedure. If the doctor discovers the cancer has spread and the tumor cannot be completely removed, the operation may be ended. Alternatively, the doctor may choose to remove a portion of the tumor if doing so alleviates some of the patient's side effects, called palliative surgery.

Prior to surgery, the doctor may prescribe somatostatin analog drugs to ease any symptoms the patient may be experiencing. These drugs work by controlling the tumor’s growth, slowing the multiplication of tumor cells. They may also be used to stop neuroendocrine tumors from releasing hormones, in turn reducing the patient's pancreatic cancer symptoms.

Other medications may be prescribed as well, such as:

  • Proton pump inhibitors (PPIs) to prevent stomach acid from building up
  • Diazoxide to prevent the patient's blood sugar from dropping

The patient may also receive other types of treatment prior to surgery, called neoadjuvant therapy, in the form of chemotherapy or radiation therapy, or a combination of both. The goal of neoadjuvant therapy is to shrink cancerous cells.

Several tests may be conducted before pancreas removal surgery to assess the patient's health, including:

The patient may be evaluated by an anesthesiologist, as well as the surgeon, to plan for the procedure. If the patient's spleen is to be removed, his or her immune system won’t work as well as it did before. The care team may prescribe immunotherapy drugs and let the patient know if he or she needs any additional immunizations, which should be done three weeks prior to the procedure.

In the days before surgery, the doctor may also prescribe a bowel preparation regimen. Patients on certain medications, such as blood thinners, may be asked to stop taking them beforehand, but be sure to follow the doctor’s specific instructions.

Also, patients should have everything at home ready for the return from the hospital. Ask any questions and have all concerns addressed well before the day of the surgery.

Benefits of pancreatectomy for cancer

Surgery is the only chance a patient has to remove all of the pancreatic cancer, according to the ACS. Even if the pancreas is not resectable, a pancreatectomy as a palliative care option may help in reducing side effects, even when the tumor has spread. 

Risks of pancreatectomy

Pancreatectomy is a major surgery that can be difficult to recover from; a full recovery may take weeks to months.

Despite the complexity of the surgery, patients without complications may be discharged from the hospital four to five days after a less-invasive procedure such as a distal pancreatectomy and six to seven days after a more complicated Whipple procedure.

It’s possible to have complications from a pancreatectomy even when the surgery goes well, including:

  • Infections
  • Bleeding
  • Leaking from the surgical site (because of newly connected organs)
  • Difficulties with gastric emptying
  • Digestion issues
  • Weight loss
  • Changes in bowel habits
  • Diabetes

Pancreatectomy results

In the best-case scenario, a pancreatectomy removes the cancer. In more advanced cases, it may relieve the patient's symptoms. The odds of the pancreatic NETs being fully removed depend on several factors, including:

  • Type of cancer cell present in the tumor
  • Location of the tumor in the pancreas (head, body or tail)
  • Whether the tumor is localized, or if it spread beyond the pancreas
  • Whether the patient has the rare disorder multiple endocrine neoplasia type 1 (MEN1) syndrome, which causes tumors to grow in the endocrine glands
  • The patient's age and level of wellness
  • Whether the cancer is new or a recurrence from a previous cancer

Life after pancreatectomy

Depending on the extent of the tumor and whether it’s spread, the cancer may have been completely removed by the surgery or may still be present in other areas. As with all types of cancer, there’s also always a chance of recurrence, and patients who have had a pancreatic NET are at greater risk of developing other cancers, such as:

It’s a good idea to work with the care team to design a survivorship care plan that includes:

  • Schedule of follow-up appointments and additional testing (including screening tests)
  • Thorough description of possible side effects and symptoms, along with what to do if they occur 
  • List of lifestyle changes that may reduce the chances of the cancer returning, such as following a healthy diet and exercise routine and avoiding smoking and alcohol

Close monitoring of symptoms after surgery is important. The care team may advise whether any new medications will be necessary after the surgery.

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