Resections consist of removing part of the gland (very rarely all of it). The two most frequently performed involve the head of the pancreas (operation called pancreaticoduodenectomy or DPC) or the body and tail (left pancreatectomy) sometimes with associated resection of the spleen (left pancreatectomy).<\/span><\/p>\n Despite the sophisticated tests that doctors use to diagnose pancreatic cancer, they are not always able to establish the stage of the cancer before doing the surgery.<\/span><\/p>\n The results of imaging tests may show that the tumor can be removed by surgery, that is, it is resectable. However during surgery, doctors may find that it is not possible to remove it. This means that the tumor is not resectable, or that the cancer has spread (metastasized).<\/span><\/p>\n If doctors decide the tumor is unresectable or find metastases, they may do palliative surgery. This type of surgery can relieve pain or treat or prevent symptoms caused by blockage of the common bile duct or duodenum (first part of the small intestine).<\/span><\/p>\n The following types of surgery are used to treat pancreatic cancer or to relieve symptoms of advanced cancer. You may also receive other treatments after surgery (chemotherapy).<\/span>[\/vc_column_text][vc_column_text]\n The pancreas is a gland located in the abdomen, between the stomach and the kidneys. It is made up of three parts: the head, the body and the tail. <\/span> It produces hormones. As such, it is endocrine (since it produces hormones). It also secretes substances intended to be expelled from the body. As such, it is also exocrine.<\/span><\/p>\n Regarding its endocrine function, the pancreas secretes many hormones for blood flow, such as glucagon, somatostatin, etc. The best known is insulin, which is responsible for regulating blood sugar (in other words, blood sugar levels). A lack of insulin in the blood is responsible for diabetes.<\/span><\/p>\n Regarding its exocrine function, the pancreas produces a liquid flowing into the duodenum. This liquid is composed of many enzymes intended for the digestion of food. Exocrine cells represent more than 90% of the pancreas.<\/span><\/p>\n All of its functions are therefore essential for the proper functioning of the body. <\/span><\/p>\n When the pancreas fails, it is possible to compensate for the loss of function by:<\/span><\/p>\n When the pancreas is diseased, surgery<\/strong> may be helpful<\/span>. Such <\/span>surgical treatment<\/strong> is<\/span> invasive. It is reserved only for the most serious illnesses.<\/span>[\/vc_column_text][vc_column_text]\n Medicine relies on the two secretory functions of the pancreas in order to understand the occurrence of quite specific diseases.<\/span>[\/vc_column_text][toggles style=”minimal” accordion=”true”][toggle color=”Default” title=”Acute pancreatitis”][vc_column_text]This condition is a sudden inflammation of the pancreas. Its intensity is more or less severe depending on the case.<\/span><\/p>\n In the occurrence of acute pancreatitis, certain digestive enzymes are massively released and activated directly in the pancreas. In fact, the enzymes will start autodigestion of the pancreas. Lesions are created in the organ, which can become necrotic in the most serious cases.<\/span><\/p>\n In general, excessive alcohol consumption or the migration of gallstones are known to be the cause of acute pancreatitis.<\/span><\/p>\n Indications for surgical treatment<\/strong> in acute pancreatitis are very rare. In most cases, surgery is unnecessary.<\/span>[\/vc_column_text][vc_column_text]The gallbladder is in the form of a small sac 7 to 12 cm long connected to the bile ducts through the duodenum via the common bile duct. Pear-shaped, it stores bile produced by the liver. Bile allows the absorption of fat-soluble vitamins (A, D, E and K) and the digestion of fats. However, its role is moderately important in digestion.<\/p>\n When eating, the gallbladder contracts. It then releases the bile which is routed through the common bile duct and then into the small intestine. (Source: https:\/\/www.fmcgastro.org\/postu-main\/archives\/postu-2012-paris\/textes-postu-2012-paris\/surveillance-des-tumeurs-intracanalaires-papillaires-et-mucineuses-du-pancreas %E2% 80%89-who-and-how\/) (Source: https:\/\/www.fmcgastro.org\/postu-main\/archives\/postu-2012-paris\/textes-postu-2012-paris\/conduite-a-tenir-diagnostic-devant-une-tumeur-cystique-du -pancreas\/) The classification of pancreatic endocrine tumors is broad. (Source: http:\/\/www.centre-hepato-biliaire.org\/ Maladies\/cancers\/adenocarcinome-pancreas.html) Apart from secreting endocrine tumors, identified by inappropriate hormone secretion, pancreatic lesions have no specific symptoms. <\/span><\/p>\n It is by their impact on the neighboring organs that they are signaled: <\/span><\/p>\n Resections consist of removing part of the gland (very rarely all of it). The two most frequently performed involve the head of the pancreas (operation called pancreaticoduodenectomy or DPC) or the body and tail (left pancreatectomy) sometimes with associated resection of the spleen (left pancreatectomy).<\/span><\/p>\n Despite the sophisticated tests that doctors use to diagnose pancreatic cancer, they are not always able to establish the stage of the cancer before doing the surgery.<\/span><\/p>\n The results of imaging tests may show that the tumor can be removed by surgery, that is, it is resectable. However during surgery, doctors may find that it is not possible to remove it. This means that the tumor is not resectable, or that the cancer has spread (metastasized).<\/span><\/p>\n If doctors decide the tumor is unresectable or find metastases, they may do palliative surgery. This type of surgery can relieve pain or treat or prevent symptoms caused by blockage of the common bile duct or duodenum (first part of the small intestine).<\/span><\/p>\n The following types of surgery are used to treat pancreatic cancer or to relieve symptoms of advanced cancer. You may also receive other treatments after surgery (chemotherapy).<\/span>[\/vc_column_text][toggles style=”minimal” accordion=”true”][toggle color=”Default” title=”Left pancreatectomy or left splenopancreatectomy: surgery on the left side (body and tail of the pancreas)”][vc_column_text]Left pancreatectomies are more or less extensive. Depending on the size and location of the lesions to be removed, they may or may not involve the spleen. Its conservation is desirable, but not always possible. <\/span><\/p>\n The slice of pancreatic section is sutured but not connected to the intestine, which eliminates the risk described above of an anastomotic leak. Nevertheless, an isolated leak of pancreatic fluid can be externalized. Since there is no intestinal opening, source of infection, its consequences are much less serious.<\/span><\/p>\n Resection of the distal part of the pancreas (tail) and spleen can be performed laparoscopically. Other resections are possible, but infrequently performed: central resection leaving the head and tail of the pancreas in place, enucleation of a benign tumour, without removing the neighboring gland.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Pancreaticoduodenectomy: surgery on the right side (head of the pancreas)”][vc_column_text]The CPD removes en bloc a set of united elements: the duodenum, the head of the pancreas, the common bile duct, and the gallbladder. Exeresis (ablation) is followed by a period of reconstruction. Its purpose is to restore continuity to the digestive tract. The most common assembly first connects the pancreas to the stomach, then the bile duct and the pylorus to the small intestine. In the post-operative period, a probe is always left in place in the stomach (passing through the nose), for a period of four to eight days. Feeding by mouth is resumed only when bowel functions are restored. The essential complication of this major surgery is linked to the multiple digestive sutures, especially the suture uniting the pancreas to the stomach. A healing defect (responsible for an anastomotic fistula) is observed in almost 10% of cases in the large series in the medical literature. This complication can be the cause of local infections and reoperations for drainage. Malignant (cancer) or potentially malignant tumors of the pancreas are often treated surgically. The type of surgery performed depends mostly on the size and location of the tumour, the spread of the cancer and the possibility of resecting it. <\/span><\/p>\n You may have pancreatic surgery for several reasons: <\/span><\/p>\n After removing these organs, the surgeon attaches the remaining end of the stomach to the jejunum (gastrojejunostomy). It also attaches the remaining part of the common bile duct and pancreas to the jejunum so that bile and pancreatic juices can flow into the jejunum. These juices help neutralize stomach acid and reduce the risk of an ulcer forming in the area.<\/span><\/p>\n Finally, the surgeon attaches the remaining end of the duodenum, which is connected to the stomach, to the jejunum (duodenojejunostomy). It also attaches the remaining part of the common bile duct and pancreas to the jejunum so that bile and pancreatic juices can flow into the jejunum.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Distal pancreatectomy”][vc_column_text]Distal pancreatectomy is done when the tumor is in the body or tail of the pancreas. The surgeon removes the tail of the pancreas, or the tail and part of the body of the pancreas, along with nearby lymph nodes. <\/span><\/p>\n In cases where the tumor has spread to the spleen or to the blood vessels supplying the spleen, the surgeon will remove it. The head of the pancreas remains attached to the duodenum.<\/span>[\/vc_column_text][vc_column_text][\/vc_column_text][\/toggle][toggle color=”Default” title=”Total pancreatectomy”][vc_column_text]Surgeons rarely resort to total pancreatectomy. Multidisciplinary medicine can consider this surgery in several cases: <\/span><\/p>\n During this procedure, the surgeon removes the entire pancreas, duodenum (first segment of the small intestine), pylorus (lower section of the stomach which is connected to the duodenum), part of the common bile duct, the gall bladder and sometimes the spleen and nearby lymph nodes.<\/span><\/p>\n After removing these organs, the surgeon attaches the remaining end of the stomach to the jejunum (gastrojejunostomy). It also attaches the remaining part of the common bile duct to the jejunum so that bile can flow into the jejunum.<\/span><\/p>\n Since the entire pancreas is removed, patients will develop diabetes: they will need to take insulin. Diabetes is a disease that is often difficult to control.<\/span><\/p>\n The pancreas generally makes enzymes that help digest food. People who undergo a total pancreatectomy will therefore have to take enzyme replacement therapy for the rest of their lives.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Bypass surgery”][vc_column_text]Palliative surgery can be used to relieve symptoms of unresectable pancreatic cancer, either locally advanced or metastatic, or recurrent.<\/span><\/p>\n Tumors located in the head of the pancreas often block the common bile duct or duodenum. Palliative surgery may relieve the symptoms of the blockage. In some cases, a surgical bypass may be done to clear the blockage caused by a tumor in the pancreas.<\/span><\/p>\n The type of surgical bypass performed to help bile flow around the blockage is called a biliary bypass. Different types of biliary diversion are used depending on the location of the blockage:<\/span><\/p>\n Gastric bypass, or gastrojejunostomy, attaches the stomach directly to the jejunum. This surgery is sometimes performed to avoid a second operation. Indeed, the probability of obstruction of the duodenum in case of progression of the disease is not negligible.<\/span>[\/vc_column_text][\/toggle][\/toggles][vc_column_text]\n It is important to know that different doctors practicing in different medical and surgical specialties will work as a team to provide your treatment:<\/span><\/p>\n <\/p>\n The formation of such a<\/span> multidisciplinary<\/strong> (or<\/span> multidisciplinary<\/strong> ) team guarantees the meeting of all the essential skills in order to optimize your care.<\/span> The choice of the type of treatment and your prognosis (chance of cure) depends on the situation and the evolutionary stage of the malignancy. What is the significance of pancreatic invasion? Are there extensions in neighboring tissues (arteries and veins) or in distant tissues (lymph node, liver, lungs, etc.)? What type of tumor is it? What is his size ? What is your state of health? <\/span><\/p>\n To determine all of these factors, additional examinations will be carried out: <\/span><\/p>\n The results of the examinations provide information on the nature and extent of the condition. This does not presage consequences and evolution. <\/span><\/p>\n The results of the various examinations make it possible to determine the optimal methods of your care according to the recommendations for care issued by the health authorities. After discussing your case with the multidisciplinary team, your doctor will discuss the results of these various examinations and the follow-up for your treatment with you. <\/span><\/p>\n It is possible for you to bring a member of your family during this exchange. <\/span>[\/vc_column_text][vc_column_text]\n After a few hours in the recovery room, you will return to your hospitalization unit for monitoring. <\/span>[\/vc_column_text][toggles style=”minimal” accordion=”true”][toggle color=”Default” title=”Postoperative pain”][vc_column_text]Pain under the ribs or towards the shoulders may appear the day after the operation. They are due to the gas required for laparoscopy. These pains always disappear in 24-48 hours.<\/span><\/p>\n This procedure generally responds well to analgesics.<\/span><\/p>\n We may be required to perform postoperative imaging to monitor the healing of the sutures.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Diet in the first days after pancreatic surgery”][vc_column_text]Please note: you will not be allowed to eat for several days.<\/span><\/p>\n In the days following the operation, you can first gradually resume drinking. After a few days and as soon as your transit allows it, a liquid then solid food will be offered to you.<\/span><\/p>\n After this type of operation, intestinal transit can be temporarily modified with, for example, diarrhea, more frequent needs or more difficult evacuation or constipation or even occlusion. Most often, these phenomena are only transient, and the functioning of the intestine normalizes. Sometimes, however, these abnormalities are more persistent and may require drug treatment.<\/span><\/p>\n As soon as your transit returns to normal, we remove the urinary catheter, drains and catheters. These have allowed us to hydrate you and soothe your pain.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Returning home after pancreatic surgery”][vc_column_text]In the absence of complications, your hospitalization after pancreatic surgery lasts between 5 and 10 days. When you leave, pain medication is prescribed. In some cases, a home nurse will be needed to support you in certain actions.<\/span><\/p>\n You will gradually resume your daily activities and light activity. <\/span><\/p>\n A work stoppage of 4 weeks will be prescribed for you (taking into account the particularities of your work).<\/span><\/p>\n One month after the operation, you come to your postoperative consultation. Depending on the evolution of your condition, your surgeon then authorizes you to resume your physical and sporting activities.<\/span>[\/vc_column_text][\/toggle][\/toggles][toggles style=”minimal” accordion=”true”][toggle color=”Default” title=”Postoperative pain”][vc_column_text]Pain under the ribs or towards the shoulders may appear the day after the operation. They are due to the gas required for laparoscopy. These pains always disappear in 24-48 hours.<\/span><\/p>\n This procedure generally responds well to analgesics.<\/span><\/p>\n We may be required to perform postoperative imaging to monitor the healing of the sutures.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Diet in the first days after pancreatic surgery”][vc_column_text]Please note: you will not be allowed to eat for several days.<\/span><\/p>\n In the days following the operation, you can first gradually resume drinking. After a few days and as soon as your transit allows it, a liquid then solid food will be offered to you.<\/span><\/p>\n After this type of operation, intestinal transit can be temporarily modified with, for example, diarrhea, more frequent needs or more difficult evacuation or constipation or even occlusion. Most often, these phenomena are only transient, and the functioning of the intestine normalizes. Sometimes, however, these abnormalities are more persistent and may require drug treatment.<\/span><\/p>\n As soon as your transit returns to normal, we remove the urinary catheter, drains and catheters. These have allowed us to hydrate you and soothe your pain.<\/span>[\/vc_column_text][\/toggle][toggle color=”Default” title=”Returning home after pancreatic surgery”][vc_column_text]In the absence of complications, your hospitalization after pancreatic surgery lasts between 5 and 10 days. When you leave, pain medication is prescribed. In some cases, a home nurse will be needed to support you in certain actions.<\/span><\/p>\n You will gradually resume your daily activities and light activity. <\/span><\/p>\n A work stoppage of 4 weeks will be prescribed for you (taking into account the particularities of your work).<\/span><\/p>\n One month after the operation, you come to your postoperative consultation. Depending on the evolution of your condition, your surgeon then authorizes you to resume your physical and sporting activities.<\/span>[\/vc_column_text][\/toggle][\/toggles][vc_column_text]\n When you leave, the medical team has provided you with a series of documents to keep. These documents include the telephone number of the surgery secretariat and the telephone number of the general practitioner on duty practicing at the Charcot clinic in Lyon. This general practitioner is reachable 24 hours a day, 7 days a week. <\/span><\/p>\n He can, if he deems it necessary, hospitalize you. Do not hesitate to contact us.<\/span><\/p>\n In any case, you absolutely must contact your surgeon in case of;<\/span><\/p>\n To ensure a speedy recovery, we would like to draw your attention to a few important points:<\/span><\/p>\nWhat is the pancreas?<\/b><\/h1>\n
\n<\/span>This gland is traversed by a network of ducts which serve to transport pancreatic juice. All of these channels come together in a central channel, the <\/span>Wirsung channel.<\/strong><\/p>\n\n
What are serious diseases of the pancreas?<\/b><\/h1>\n
\nAfter eating, the gallbladder begins to fill with bile which will be released during the next meal.[\/vc_column_text][\/toggle][toggle color=”Default” title=”Potentially malignant tumors of the pancreas”][vc_column_text]There are very many tumoral lesions of the pancreas. We will only mention a few of them here, including potentially malignant tumours.<\/p>\nThe TIPMP<\/h4>\n
\nThe papillary and mucinous intraductal tumor of the pancreas is a well-known disease. It is caused by an overgrowth of the ductal epithelium. In at least 60% of cases, the discovery is made fortuitously, now during an imaging examination carried out for another cause.
\nThis type of tumor is benign, that is, it is not a cancerous form. However, there are risks of progression to a malignant (cancerous) form. The risk factors for a malignant evolution are rather well determined.
\nThere are indications for surgery, based on a global consensus. If the surgical option is not chosen, a serious monitoring protocol should be put in place.<\/p>\nmucinous cystadenoma<\/h4>\n
\nIt is a cyst whose particularity is not to be in communication with the pancreatic ducts. It is almost always located in the body or in the tail of the pancreas. This type of pancreatic tumor is most frequently found in female subjects of mature age (between 40 and 60 years old).
\nDue to the high risk of cancerous degeneration (20%), preventive surgical resection is justified. In case of degeneration, the benign cyst transforms into cystadenocarcinoma.<\/p>\npancreatic endocrine tumor<\/h4>\n
\nThey are classified according to their functional or non-functional character. In other words, this type of tumor is associated with signs of hormonal hypersecretion.
\nThe risk of degeneration evolves according to the type of endocrine tumour.
\n[\/vc_column_text][\/toggle][toggle color=”Default” title=”Malignant tumors: pancreatic cancer”][vc_column_text]Note: exocrine cells are the most numerous in the pancreas. Thus, most pancreatic cancers develop from exocrine cells.
\nWe will only discuss one type of pancreatic cancer here.<\/p>\nDuctal adenocarcinoma of the pancreas<\/h4>\n
\nPancreatic ductal adenocarcinoma is the most common form of pancreatic cancer. It affects between 1 to 10 people per 100,000 inhabitants.
\nIt is a disease more common in male patients. Most patients diagnosed are over 50 years old.
\nDiabetes is an associated disease in half of pancreatic cancer cases.
\nThe symptoms are:
\nsudden weight loss;
\nasthenia (significant fatigue);
\nanorexia (loss of appetite);
\nabdominal pain.
\nThe examinations necessary to confirm the diagnosis should be carried out before considering surgery for pancreatic cancer:
\nblood test with liver test;
\nAbdominal ultrasound ;
\nthen if cancer is suspected, blood test for assay of tumor markers;
\nto scan ;
\necho-endoscopy;
\nbiopsy if necessary.
\n[\/vc_column_text][\/toggle][\/toggles][vc_column_text]\nHow do potentially malignant tumors or malignant pancreatic tumors manifest?<\/b><\/h1>\n
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Pancreatic surgeries<\/b><\/h1>\n
\nPancreaticoduodenectomy must be performed by laparotomy. The incision will leave a scar of varying size on the patient’s abdomen.
\nIts duration ranges from 4 to 6 hours, depending on local difficulties and possible complications.
\nA blood transfusion may be necessary, especially in case of preoperative anemia.<\/p>\nDiet and pancreaticoduodenectomy<\/h4>\n
\nSometimes, especially if the pre-operative nutritional status is altered, a probe is placed during the operation in the small intestine to allow the rapid resumption (D1 or D2) of food (other than intravenously).<\/p>\nWhat complications for a pancreaticoduodenectomy<\/h4>\n
\nMortality related to this operation has dropped considerably over the past 20 years. It is now below 5% and remains strongly linked to the terrain (existence of pathologies associated with the heart, lungs, etc.), and to age.
\nFrom a distance, this surgical intervention makes it possible to lead a normal life, to have a normal diet (almost always with enzyme supplementation by tablets). It does not trigger diabetes (unless the pancreas left in place was also sick, as in chronic pancreatitis for example).
\n[\/vc_column_text][\/toggle][\/toggles][vc_column_text]\nHow is pancreatic surgery performed?<\/b><\/h1>\n
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What is my background during pancreatic surgery at Clinique Charcot in Lyon?<\/b><\/h1>\n
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\n<\/span>You will therefore be put in contact with different doctors during your treatment. Their common goal is <\/span>cancer treatment<\/strong> .<\/span><\/p>\n\n
How are the days after pancreatic surgery?<\/b><\/h1>\n
What to do in case of problems at home after pancreatic surgery?<\/b><\/h1>\n
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Post-operative advice after pancreatic surgery<\/b><\/h1>\n
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