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Pancreatectomy for neuroendocrine tumors

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

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

If you develop cancer 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.

Treatment for NETs has a higher rate of success than for exocrine pancreatic cancers. Your specific treatment will depend on the grade of your tumor, which is a classification for how likely it is to get bigger or spread.

Grade 1 (low-grade) NETs have cells that aren’t reproducing at a fast rate and have a more normal appearance.

Grade 2 (intermediate-grade) NETs are a cross between Grade 1 and Grade 3.

Grade 3 (high-grade) cancers consist of rapidly multiplying, abnormal cells.

Grade 1 and Grade 2 tumors are NETs that don’t grow quickly, but there’s still a chance they may metastasize to other areas. Because Grade 3 tumors grow and spread much faster, they’re labeled differently: as pancreatic neuroendocrine carcinomas (NECs).

NETs are classified as either functioning or nonfunctioning, based on whether or not they release hormones that cause symptoms. Nonfunctioning NETs are often not discovered until they’ve become quite big.

Types of functioning NETs include:

  • Insulinomas originate from insulin-producing cells (these account for up to 70 percent of all functioning NETs, according to the ACS)
  • Glucagonomas originate from glucagon-producing cells
  • Gastrinomas originate from gastrin-producing cells
  • Somatostatinomas originate from somatostatin-producing cells
  • VIPomas: originate from cells that produce vasoactive intestinal peptide
  • ACTH-secreting tumors originate from cells that produce adrenocorticotropic hormone (ACTH)
  • Carcinoid tumors originate from cells that produce serotonin (these are more commonly found in other digestive organs but are sometimes present in the pancreas)

Most often, treatment for NETs involves a surgical procedure called a pancreatectomy, which may either be used to completely remove the cancer or as a palliative option, to reduce symptoms. Pancreatectomies may be partial or whole, depending on the size, location and type of NET. Because it’s a complex surgery that may result in complications, and that typically has a long and difficult recovery time, it’s important to discuss the risks vs. benefits with your care team first.

Types of pancreatectomy

The specific type of pancreatectomy used to treat your NET is based on the grade and location of your tumor.

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

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 your surgeon determines whether open or laparoscopic surgery is appropriate based on the extent of the cancer.

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

Central pancreatectomy: The neck of the pancreas and a portion of its body are removed, but the head and tail remain to preserve function of the organ.

Distal pancreatectomy: The tail and a portion of the body of the pancreas is removed, often along with the spleen.

Whipple procedure (pancreaticoduodenectomy): The head and sometimes part of the body are removed, along with:

  • Lymph nodes
  • Portion of stomach and small intestines
  • Part of bile duct
  • All of your gallbladder

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

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

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

How to prepare for a pancreatectomy and what to expect

Before you have a pancreatectomy, you will likely undergo a laparoscopy to determine the location and extent of the tumor. Even so, your surgeon won’t always know whether your 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, your doctor may choose to remove a portion of the tumor if doing so alleviates some of your side effects, called palliative surgery.

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

Other medications may be prescribed as well, such as:

  • Proton pump inhibitors (PPIs) to prevent stomach acid from building up
  • Diazoxide to prevent your blood sugar from dropping

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

Several tests may be conducted before your surgery to assess your health, including:

You may be evaluated by an anesthesiologist, as well as your surgeon, to plan for the procedure. If your spleen is to be removed, your immune system won’t work as well as it did before. Your doctor may prescribe immunotherapy drugs and let you know if you need any additional immunizations, which should be done three weeks prior to your procedure.

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

Also, be sure you have everything you need at home ready for your return from the hospital. Ask any questions you may have and have your concerns addressed well before the day of your 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 it’s not resectable, a pancreatectomy as a palliative 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

Results of pancreatectomy

In the best-case scenario, a pancreatectomy removes the cancer. In more advanced cases, it may relieve your 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 you have the rare disorder multiple endocrine neoplasia type 1 (MEN1) syndrome, which causes tumors to grow in your endocrine glands
  • Your age and level of wellness
  • Whether your cancer is new or a recurrence from a previous cancer

What life will be like after your pancreatectomy

Depending on the extent of your tumor and whether it’s spread, the cancer may have been completely removed by the surgery, or it may still be present in other areas. As with all types of cancer, there’s always a chance or 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 your doctor 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 you experience them
  • 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 your symptoms after surgery is important. Your doctor can let you know if you need to take any new medications after your surgery.

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