Pancreas Surgery

Pancreatitis involves inflammation of the pancreas and can be either acute or chronic. Common causes of this inflammation include gallstones, alcohol consumption, elevated blood lipids, certain medications, high calcium levels in the blood, and autoimmune responses. However, in some instances, the underlying cause remains unidentified. Patients with pancreatitis typically experience severe abdominal pain, swelling, fever, and vomiting.

Lesions or tumours in the pancreas can be cystic or solid. Pancreatic cysts are fluid-filled sacs lined with cells. While most are non-cancerous, some can be or contain pre-cancerous lesions. The majority of pancreatic tumours originate in the cells lining the pancreatic duct. Less commonly, cancers develop from enzyme-producing cells or other cells within the pancreas. Approximately 1% of pancreatic tumours originate from hormone-producing cells. These neuroendocrine tumours may produce excess hormones like insulin, leading to symptoms of very low blood sugar, or they may not produce hormones and thus cause no symptoms.

Serous cystadenomas, often discovered incidentally during imaging, are fluid-filled lesions that are benign. Typically, the recommended approach is observation without surgical intervention. However, surgery may be considered if the tumors show growth or cause related symptoms like obstruction and pain.

Invasive ductal adenocarcinoma is the most prevalent form of pancreatic cancer. Characteristically, early stages are asymptomatic, leading to diagnoses at advanced stages in most individuals. Consequently, only a small fraction, approximately 10-20%, are candidates for curative surgical removal upon detection.

Pancreatic neuroendocrine tumours originate in the pancreas’ hormone-producing cells. Their presentation varies, including symptoms related to a pancreatic mass (such as bile duct or stomach obstruction, or pancreatitis), local spread, excessive hormone production, or non-specific indicators like abdominal pain and weight loss. Detection can be challenging, and these tumours are frequently found after metastasizing, commonly to the liver.

Mucinous cystic neoplasms are typically large cystic lesions found in the body and tail of the pancreas, predominantly affecting women around 55 years old. These can be aggressive, and complete surgical removal is usually the most effective treatment. Intraductal papillary mucinous neoplasms (IPMN) are cystic lesions arising from the pancreatic duct system. They produce thick mucin, sometimes causing pancreatitis-like symptoms and are slightly more common in males. Management is often monitoring, but at times a surgical resection is necessary.

The treatment of pancreatic cancer varies and is dependent on whether the disease is confined to the pancreas or has extended into vital adjacent structures (e.g., vessels) or spread to other organs (e.g. liver). In cases where surgery is not indicated, chemotherapy or radiation may be used.