What is total pancreatectomy?
During the operation, the pancreas is removed completely.
Depending on the nature of the disease, the following may also be removed:
- the duodenum
- the gallbladder
- the distal part of the common bile duct
- the spleen
- the regional lymph nodes
- if necessary, adjacent organs or vessels in line with oncological principles
After the organs are removed, the digestive tract is reconstructed to restore the passage of food and bile.
Our approach
At MSI, total pancreatectomy is performed only when it is the only way to achieve radical treatment.
Before surgery, the disease is fully staged using multiphase computed tomography or MRI, laboratory tests, tumor markers, and, when indicated, endoscopic ultrasound or biopsy.
Every case is discussed by the multidisciplinary team in line with guidelines from the *NCCN, ESMO, and ISGPS (International Study Group of Pancreatic Surgery)*.
*When technically feasible and oncologically safe, we aim to perform the operation laparoscopically.* The final choice of approach depends on the extent of the disease and the complexity of the procedure.
Postoperative care follows *ERAS (Enhanced Recovery After Surgery)* principles, with early mobilization and comprehensive metabolic support.
When is surgery needed?
Total pancreatectomy is performed for:
- extensive pancreatic cancer
- multiple pancreatic tumors
- diffuse IPMN with a high risk of malignant transformation
- multiple neuroendocrine tumors
- certain cases of severe chronic pancreatitis
- recurrent tumors after previous operations
- other diseases when preserving part of the pancreas is impossible
Indications for surgery
Surgery is recommended for:
- involvement of the entire pancreas
- multiple lesions in different parts of the gland
- cases where organ-preserving resection is impossible
- no distant metastases, or in selected cases after multidisciplinary discussion
How is the operation performed?
The procedure is performed under general anesthesia.
After the abdominal organs are mobilized, the pancreas is removed completely together with the necessary adjacent structures, depending on the nature of the disease. For malignant tumors, a regional lymph node dissection is performed.
After the resection stage, the bile ducts and the gastrointestinal tract are reconstructed.
The removed specimen is sent for full histopathological examination.
Advantages of laparoscopic surgery
- Performed laparoscopically whenever possible
- Less surgical trauma
- Less postoperative pain
- Faster recovery
- Lower risk of wound complications
- Shorter hospital stay
- Full adherence to international oncology standards
Recovery after surgery
After the pancreas is removed completely, the body no longer produces insulin or digestive enzymes.
After surgery, the patient needs:
- lifelong insulin therapy
- lifelong enzyme replacement therapy
- an individually tailored diet
- regular follow-up with an endocrinologist and a surgeon
Postoperative treatment follows *ERAS* principles, and patients are trained to monitor their blood glucose and take enzyme supplements.
Our advantages
- Specialization in complex pancreatic surgery
- A commitment to laparoscopic surgery when it is safe and oncologically justified
- A multidisciplinary approach to treatment
- Adherence to NCCN, ESMO, and ISGPS guidelines
- Comprehensive postoperative patient care
- Enhanced recovery program (ERAS)
- Full support after discharge, including training in insulin and enzyme replacement therapy
Frequently Asked Questions
Yes. After total pancreatectomy, lifelong insulin and enzyme supplements are needed, which maintain quality of life and compensate for the loss of organ function.
Yes. After the pancreas is removed completely, the body no longer produces insulin, so all patients need lifelong insulin therapy.
Yes. Enzyme replacement therapy is essential for normal digestion after total pancreatectomy.
In selected patients, yes. When technically feasible and oncologically safe, we aim to perform the operation laparoscopically.
For malignant tumors, further treatment is decided once the histopathology results are available and discussed by the multidisciplinary tumor board.