Why remove a pancreas in the first place?

There are several reasons we would consider removing a patient’s pancreas, including hereditary pancreatitis, chronic pancreatitis, intraductal papillary mucinous neoplasm (IPMN), and cancer.

Pancreatitis is a condition in which the pancreas becomes inflamed. The hereditary form, caused by genetic mutations, predisposes some patients to recurrent pancreatitis. These patients have up to a 40 percent risk of developing pancreatic cancer over their lifetime. For these individuals, we would consider removing the entire pancreas because the entire organ is at risk for cancer.

Chronic pancreatitis is long-lasting, and often the pain is severe. Patients who come to us with lifestyle-limiting pain from this disease may be candidates for having part or all of their pancreas removed.

IPMN is a precancerous condition. If lesions are progressing throughout the main pancreas duct, we will remove the entire pancreas to prevent IPMN from turning into pancreatic cancer.

As for cancer, surgery is an option only 20-40 percent of the time, and often the treatment involves removing only part of the pancreas. We remove the entire pancreas if a patient has more than one tumor or if he or she has an underlying disease in the pancreas as a whole even if cancer is in only part of the organ. That’s because there is a very high risk the patient will develop another cancer elsewhere in the pancreas.

Considering pancreas transplants

While pancreas transplants are possible, this procedure is not typically used for post-pancreatectomy patients. These transplants are typically considered for patients who have Type 1 diabetes and who have significant resulting conditions, including blindness and kidney failure. With new technologies, however, pancreas transplants may become a thing of the past.

A related process that may stand the test of time is islet autotransplantation. In this procedure, a physician removes the pancreas and auto digests it, isolating the islet cells that produce insulin and then fusing those cells back into the patient’s liver. The hope is these cells will engraft and grow in the liver, retaining some of the pancreas’ function.

In the United States, if a patient has cancer – or is at risk for cancer for any reason – it is considered unethical to fuse these islet cells with the liver because they have the potential to be cancerous. There are programs in France and Spain doing this with success, even in cancer patients, but in the U.S. we reserve this surgery only for patients with inflammatory conditions.

Emerging technologies

Insulin production is critical, but there are additional concerns with a total pancreatectomy. We worry more about the loss of glucagon, a counter-regulatory hormone that prevents the amount of glucose in the blood from dropping to a dangerously low level.

A promising emerging technology is the artificial pancreas. This device incorporates insulin pump technology with a continuous glucose monitor capable of interpreting blood sugar levels. Based on this information, it can then increase, decrease, or hold its secretion of insulin or glucagon accordingly. The artificial pancreas is currently in clinical trials at sites across the United States.

Life after pancreatic surgery

We find that our adult patients adapt remarkably well to the lifestyle changes necessitated by a pancreatectomy and, in effect, living without a pancreas. Patients are willing to adapt because the procedure is either addressing unrelenting pain from problems like pancreatitis or treating and preventing cancer . For those with diabetes or pancreatitis, the daily routine might not be a drastic departure because they’ve probably taken enzymes or used insulin already.

For others, though, preparing for lifestyle changes prior to the procedure is key. Before a total pancreatectomy, we always discuss with patients what life will be like without a pancreas so they can plan and understand the expectations and demands and make an informed decision.

Living without a pancreas is indeed possible, and to a degree that you’re not just surviving, but thriving.