Pancreatectomy is surgery to remove part or all of the pancreas. The type of operation you need depends mainly on where the disease is located, how much of the pancreas is affected, and what the surgery needs to achieve. The three major types are the Whipple procedure, distal pancreatectomy and total pancreatectomy.
Although all three are forms of pancreas removal surgery, they are not interchangeable. A tumor in the head of the pancreas usually requires a different operation from one in the body or tail. In some situations, removing the entire pancreas may be necessary.
Our Pancreatectomy guide provides a broader overview of pancreas removal surgery, while this article focuses specifically on how the major types differ.
What Are the Main Types of Pancreatectomy?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The three major types of pancreatectomy are:
- Whipple procedure: Removes the head of the pancreas along with nearby parts of the digestive and bile-duct system.
- Distal pancreatectomy: Removes the body and tail of the pancreas, and sometimes the spleen.
- Total pancreatectomy: Removes the entire pancreas and usually requires lifelong replacement of insulin and pancreatic digestive enzymes.
The location of the pancreatic disease is one of the most important factors determining which operation is appropriate.
Whipple Procedure: Pancreaticoduodenectomy
The Whipple procedure, medically known as pancreaticoduodenectomy, is commonly used for tumors located in the head of the pancreas. It is one of the most complex operations performed on the pancreas.
During a standard Whipple procedure, the surgeon removes:
- The head of the pancreas
- The duodenum, which is the first part of the small intestine
- The gallbladder
- Part of the bile duct
- Nearby lymph nodes
Depending on the specific surgical approach and disease, part of the stomach may also be removed. The remaining organs are then reconnected so that food, bile and pancreatic digestive secretions can continue to pass through the digestive system.
When is a Whipple procedure used?
The Whipple procedure may be considered for resectable tumors in the head of the pancreas. It can also be used for certain tumors or other conditions involving the bile duct, duodenum or nearby structures.
For pancreatic cancer, whether a Whipple procedure is possible depends not only on tumor location but also on whether the cancer can be removed completely and whether it has spread to distant organs or extensively involved major blood vessels.
Distal Pancreatectomy: Removing the Body and Tail
A distal pancreatectomy removes the body and tail of the pancreas. It is generally used when a tumor or other pancreatic disease is located in these areas.
The head of the pancreas is left in place. The spleen is located next to the tail of the pancreas, so it may also need to be removed depending on the disease and the surgical plan. However, spleen removal is not required in every distal pancreatectomy.
When is distal pancreatectomy used?
Distal pancreatectomy may be performed for selected cancers and other tumors affecting the body or tail of the pancreas.
It can also be considered for certain pancreatic cysts and other conditions where removal of the affected portion is appropriate.
For pancreatic cancer, the operation is generally considered when the tumor in the body or tail can be removed completely and there is no distant spread that would make curative surgery inappropriate.
Does distal pancreatectomy always remove the spleen?
No. The spleen may be removed during a distal pancreatectomy, but whether it is necessary depends on the location and nature of the disease, its relationship with nearby blood vessels and the goal of the operation.
When treating certain pancreatic cancers, removing the spleen may be necessary to achieve an appropriate cancer operation. In selected non-cancerous conditions, spleen-preserving surgery may be possible.
Total Pancreatectomy: Removing the Entire Pancreas
A total pancreatectomy removes the entire pancreas. Because the pancreas produces both digestive enzymes and hormones such as insulin, removing the whole organ has significant long-term effects.
A total pancreatectomy may also involve removal of nearby structures such as the duodenum, gallbladder, part of the bile duct and spleen, depending on the reason for surgery and the extent of disease.
When is total pancreatectomy considered?
Total pancreatectomy is generally reserved for selected situations rather than being the standard operation for every pancreatic tumor.
It may be considered when disease affects a large portion of the pancreas, when removing the entire gland is necessary to achieve adequate tumor clearance, or in certain other complex pancreatic conditions.
The decision involves balancing the potential benefit of removing the disease against the permanent consequences of living without a pancreas.
Whipple vs Distal vs Total Pancreatectomy
| Feature | Whipple Procedure | Distal Pancreatectomy | Total Pancreatectomy |
|---|---|---|---|
| Part removed | Head of the pancreas | Body and tail of the pancreas | Entire pancreas |
| Typical tumor location | Head | Body or tail | Extensive or selected disease involving the pancreas |
| Duodenum removed? | Yes | Usually no | Typically yes, depending on the operation |
| Gallbladder removed? | Yes | Usually no | Typically yes |
| Spleen removed? | Usually no | Sometimes | Typically yes |
| Pancreas remaining? | Yes | Yes | No |
| Lifelong insulin usually required? | Not necessarily | Not necessarily | Yes |
| Lifelong pancreatic enzyme replacement usually required? | Not always | Not always | Yes |
How Does the Location of a Pancreatic Tumor Determine the Surgery?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The pancreas is divided broadly into the head, neck, body and tail. Its position next to the stomach, small intestine, bile duct, gallbladder and major blood vessels means that pancreatic surgery often involves more than simply removing the tumor itself.
For example:
- A tumor in the head may require a Whipple procedure because the pancreatic head is closely connected with the duodenum and bile duct.
- A tumor in the body or tail may be treated with a distal pancreatectomy because these portions can often be removed while leaving the pancreatic head behind.
- Disease involving much or all of the pancreas may, in selected cases, require a total pancreatectomy.
How Does Each Type Affect Digestion?
The pancreas produces enzymes that help break down fats, proteins and carbohydrates. Removing part of the pancreas can reduce the amount of digestive enzymes available, although the degree varies between patients.
After a Whipple or distal pancreatectomy, some people continue to produce enough pancreatic enzymes, while others develop exocrine pancreatic insufficiency. This means the pancreas does not provide enough digestive enzymes for normal digestion.
Possible symptoms include:
- Loose or frequent stools
- Greasy or oily stools
- Bloating
- Abdominal discomfort
- Unintentional weight loss
- Difficulty absorbing nutrients
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
How Does Each Type Affect Blood Sugar?
The pancreas also produces insulin, which helps control blood glucose. Removing part of the pancreas can reduce insulin production, but not everyone develops diabetes after a partial pancreatectomy.
The risk depends on factors such as how much pancreatic tissue remains, the function of the remaining pancreas and the patient's pre-existing metabolic health.
After a total pancreatectomy, the body no longer has a pancreas to produce insulin. Lifelong insulin therapy is therefore required. Blood glucose needs careful monitoring and management after surgery.
What Is Life Like After a Total Pancreatectomy?
Living without a pancreas requires ongoing medical management, but patients can adapt with appropriate treatment and monitoring.
Two major forms of replacement therapy are generally required:
- Insulin replacement: Because the body can no longer produce pancreatic insulin, insulin must be administered to control blood glucose.
- Pancreatic enzyme replacement: Enzyme medicines are taken with meals and snacks to help digest food and absorb nutrients.
Patients may also need guidance from specialists in diabetes and nutrition. Blood glucose can require particularly careful management because the loss of pancreatic hormone production affects the body's ability to regulate sugar levels.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Are These Surgeries Always Open Procedures?
No. Pancreatectomy can be performed through an open approach or, in appropriately selected patients, using minimally invasive techniques.
Minimally invasive surgery may involve laparoscopic or robotic techniques. Whether these approaches are appropriate depends on the type and extent of disease, the planned operation, the surgeon's experience and the patient's overall condition.
Complex pancreatic cancer surgery may require an open approach, particularly when the tumor involves nearby structures or blood vessels.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The Bottom Line
The three major types of pancreatectomy are designed for different situations. The Whipple procedure is generally used for disease in the head of the pancreas, while a distal pancreatectomy removes the body and tail.
A total pancreatectomy removes the entire pancreas and is reserved for selected cases because it creates a lifelong need for insulin and pancreatic enzyme replacement.
The right operation is not determined by the name or size of the tumor alone. Doctors consider its location, extent, relationship with nearby organs and blood vessels, whether it has spread, the patient's overall health and the goal of treatment.
Understanding these differences can help patients better understand why a particular type of pancreatectomy has been recommended.
