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If you’ve been told that you may need pancreatic surgery, the thought of losing part or all of your pancreas can be concerning.
Having your pancreas removed does not mean you cannot continue living a fulfilling life, but you may need ongoing treatment and adjustments to your daily routine.
This guide explains the differences between total and partial pancreatectomy, why your surgeon recommends each procedure, and what to expect after surgery.
What Does the Pancreas Do?
The pancreas sits behind your stomach and plays an important role in digestion and blood sugar control.
It produces:
- Digestive enzymes: These help break down fats, proteins and carbohydrates so your body can absorb nutrients.
- Hormones: Insulin helps lower blood sugar, while glucagon helps raise it when levels fall too low.
If surgery is needed to remove diseased pancreatic tissue, the amount of healthy pancreas left behind can affect your digestion and blood sugar control.
What Are the Types of Pancreatectomy?
A pancreatectomy involves removing part or all of the pancreas. The procedure your surgeon recommends depends on where the condition is located and how much tissue needs to be removed.
Distal Pancreatectomy
A distal pancreatectomy removes the tail and usually part of the body of the pancreas.
Your surgeon may recommend it for tumours, cysts or other conditions affecting these areas. Depending on the condition and whether nearby blood vessels are involved, your surgeon may also need to remove your spleen.
Central Pancreatectomy
A central pancreatectomy removes the middle portion of the pancreas while preserving the head and tail. Your surgeon may recommend this procedure for certain non-cancerous or slow-growing tumours.
Leaving more healthy pancreatic tissue intact may help preserve digestion and blood sugar control, although the procedure carries a higher risk of pancreatic fluid leakage than some other operations.
Whipple Procedure (Pancreaticoduodenectomy)
The Whipple procedure removes the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder and part of the bile duct. In some cases, part of the stomach is also removed.
The surgeon preserves the remaining pancreas and reconnects it to the digestive system. This procedure is commonly performed to treat tumours in the head of the pancreas or nearby structures.
Total Pancreatectomy
Unlike the Whipple procedure, a total pancreatectomy removes the entire pancreas. Your surgeon also removes the duodenum, gallbladder and part of the bile duct, and may need to remove the spleen or part of the stomach.
With no pancreatic tissue remaining, you will need lifelong insulin and digestive enzyme replacement.
Total vs Partial Pancreatectomy: What Are the Key Differences?
The main difference is whether any pancreatic tissue remains after surgery. This affects how much insulin and digestive enzymes your body can continue producing.
| Total pancreatectomy | Partial pancreatectomy | |
|---|---|---|
| Amount removed | Entire pancreas | Part of the pancreas |
| Insulin production | Stops completely | May continue |
| Digestive enzymes | Lifelong replacement needed | May be needed |
| Diabetes | Develops after surgery | Depends on remaining function |
| Long-term care | Lifelong medication and monitoring | Depends on pancreatic function |
Preserving part of the pancreas may reduce the need for lifelong treatment, but it is not always possible or appropriate. Your surgeon must also consider whether the operation can adequately treat the underlying disease.
When Is a Total Pancreatectomy Recommended?
Your surgeon may recommend total pancreatectomy surgery when the condition affects multiple areas of the pancreas or cannot be adequately treated with a smaller operation.
Possible reasons include:
- Pancreatic cancer or certain tumours involving several areas.
- Selected pancreatic cystic conditions affecting much of the organ.
- Extensive pancreatic disease that makes partial removal unsuitable.
- Severe chronic pancreatitis in selected patients whose symptoms have not responded to other treatments.
For some people with chronic pancreatitis, a total pancreatectomy may be combined with islet autotransplantation.
During this procedure, the surgeon removes insulin-producing cells from the pancreas and transfers them into the liver, where they may continue producing insulin. This can reduce the amount of insulin needed after surgery, although it does not work for everyone.
This specialised procedure is not suitable for everyone. Your surgeon will consider the expected benefits of removing the entire pancreas alongside the surgical risks and long-term treatment needs.
Is Pancreatectomy Major Surgery?
Yes. A pancreatectomy is major surgery because the pancreas sits close to several important organs and blood vessels. The procedure may be more complex if your surgeon needs to remove a larger portion of the pancreas or nearby organs.
What Are the Open, Laparoscopic and Robotic Approaches?
Your surgeon may use one of three approaches:
- Open surgery: The surgeon makes a larger incision in your abdomen to reach the pancreas.
- Laparoscopic surgery: The surgeon uses a camera and specialised instruments to operate through several small incisions.
- Robotic surgery: The surgeon controls robotic instruments through small incisions while viewing the surgical area on a magnified screen.
Both laparoscopic pancreatic surgery and robotic surgery use smaller incisions, but they may not be suitable for every patient. Your surgeon will consider the condition being treated, the extent of the surgery and your overall health before recommending an approach.
What Are the Possible Risks and Complications?
Like other major abdominal operations, pancreatic surgery carries risks such as bleeding, infection, blood clots and wound-healing problems.
Other possible complications include:
- Pancreatic fluid leakage: Fluid may leak from the remaining pancreas or surgical connections after certain partial procedures.
- Delayed stomach emptying: Food may pass through the stomach more slowly, causing nausea or difficulty eating.
- Digestive problems: Changes in pancreatic function may affect how well your body absorbs nutrients.
- Blood sugar changes: Removing pancreatic tissue may affect insulin production.
The likelihood of complications depends on the procedure, your overall health and other medical factors.
If you have been advised to undergo pancreatectomy surgery, our surgeons at Digestive & Liver Surgery can assess your condition and discuss the proposed operation, including its risks and possible alternatives. Book an appointment here.
Can You Live Without a Pancreas?
Yes. You can continue living without a pancreas after total pancreatectomy surgery, with lifelong treatment to help your body manage blood sugar and digest food.
Your medical team will work with you to manage these changes through medication, dietary adjustments and regular follow-up care. While adapting to life after surgery may take time, ongoing care can help you manage your health and daily activities.
How Is Diabetes Managed After Surgery?
Without a pancreas, your body can no longer produce insulin or glucagon. You will therefore develop diabetes and need lifelong insulin treatment.
Your diabetes care team will help you monitor blood sugar levels and adjust your medication. Treatment may involve insulin injections or an insulin pump, sometimes alongside continuous glucose monitoring.
Blood sugar can be more difficult to manage because glucagon loss also increases the risk of low blood sugar. Ongoing diabetes care is therefore important after surgery.
Why Is Pancreatic Enzyme Replacement Needed?
After a total pancreatectomy, you will need lifelong pancreatic enzyme replacement therapy (PERT) to help digest food and absorb nutrients. You will need to take these capsules with meals and snacks.
Without enough enzymes, you may experience bloating, diarrhoea, greasy stools or weight loss. Your doctor will adjust your dosage based on your symptoms and dietary needs.
How Does Surgery Affect Diet and Weight?
Changes in digestion, appetite and blood sugar control can make eating and maintaining your weight more challenging.
Your medical team may recommend:
- Eating smaller, more frequent meals if you find larger portions difficult.
- Taking prescribed enzymes with meals and snacks.
- Monitoring your weight and nutritional intake.
- Adjusting carbohydrate intake alongside insulin treatment.
- Consulting a dietitian if you experience ongoing digestive symptoms or weight loss.
What Can You Expect During Recovery After Pancreatectomy?
After surgery, your medical team will manage your pain, monitor your recovery and help you gradually resume eating and walking. Most patients stay in hospital for several days, although this varies.
At home, you may experience fatigue, reduced appetite, or abdominal discomfort. Your surgeon will check your healing during follow-up appointments and advise when you can safely return to work, drive, exercise and lift heavy objects. Recovery may take several weeks or longer, depending on the procedure.
Frequently Asked Questions About Pancreatectomy
Will I Develop Diabetes After a Partial Pancreatectomy?
Not necessarily. Your risk depends on how much healthy pancreatic tissue remains and how well it functions. Your doctor will monitor your blood sugar after surgery and recommend treatment if needed.
How Long Will I Need Enzyme Supplements?
After a total pancreatectomy, you will need enzyme supplements for life. Following a partial pancreatectomy, your doctor will assess whether supplementation is necessary based on your remaining pancreatic function.
Can the Pancreas Grow Back?
No. Unlike the liver, the pancreas does not regrow after surgical removal. However, any remaining pancreatic tissue may continue producing insulin and digestive enzymes.
Speak to a Surgeon About Pancreatectomy
If you are considering pancreatic surgery, you may have questions about the procedure, possible risks and how it could affect your daily life.
At Digestive & Liver Surgery, our surgeons have experience in pancreatic surgery and can assess your condition, explain available treatment options, and discuss what to expect during recovery.
