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situated farthest from point of attachment or origin, as of a limb or bone
directed away from the midline or mesial plane of the body
surgical removal of part or all of the pancreas

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中心から遠い,末梢(まっしょう)[部]の,末端[部]の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/09 15:32:33」(JST)

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In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. These procedures are used in the management of several conditions involving the pancreas, such as benign pancreatic tumors, pancreatic cancer, and pancreatitis.

Indications

It is performed for a variety of reasons, including:

Inflammation
- Necrotising pancreatitis
- Chronic pancreatitis with pain
Trauma
Neoplasms
- Adenocarcinoma (85%)
- Cystadenoma (mucinous/serous)
- Cystadenocarcinoma
- Islet cell tumors (neuroendocrine tumors)
- Papillary cystic neoplasms
- Lymphoma
- Acinar cell tumors
Severe hyperinsulinemic hypoglycemia

Types

The most common surgical procedure involving removal of a portion of the pancreas is called a pancreaticoduodenectomy.

Among common consequences of complete or nearly complete pancreatectomy are deficiencies of pancreatic endocrine or exocrine function requiring replacement of insulin or digestive enzymes. The patient immediately develops type I diabetes, with little hope for future type I diabetes treatments involving the restoration of endocrine function to a damaged pancreas, since the pancreas is either partially or completely absent. Type I diabetes can be treated with careful blood glucose monitoring and insulin therapy. Because the Pancreas is responsible for the production of many digestive enzymes, a pancreatectomy should only be given as an option for pancreatic disease which is life-threatening, such as pancreatic cancers. It is very important to note that even after a pancreatectomy, pain still exists in most patients.

A distal pancreatectomy is removal of the body and tail of the pancreas.

Prognosis

Prognosis for patients living without a pancreas is very poor. Without the endocrine hormones (glucagon, insulin, somatostatin, and pancreatic polypeptide) or the exocrine enzymes (trypsin, chymotrypsin, pancreatic lipase and amylase) a patient would be on a lengthy regimen of medications and would be severely limited in his or her diet.

An adjunct procedure called islet cell transplantation exists to help mediate the loss of endocrine function following total pancreatectomy.

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English Journal

Comparison of open with laparoscopic distal pancreatectomy: a single institution's transition over a 7-year period.

Stauffer JA, Rosales-Velderrain A, Goldberg RF, Bowers SP, Asbun HJ.SourceDepartment of General Surgery, Mayo Clinic, Jacksonville, FL, USA.
HPB : the official journal of the International Hepato Pancreato Biliary Association.HPB (Oxford).2013 Feb;15(2):149-55. doi: 10.1111/j.1477-2574.2012.00603.x. Epub 2012 Nov 5.
OBJECTIVES: Many studies have shown laparoscopic distal pancreatectomy (LDP) to have benefits over open distal pancreatectomy (ODP). This institution made a unique abrupt transition from an exclusively open approach to a preference for the laparoscopic technique. This study aimed to compare outcomes
PMID 23297726

Defining quality for distal pancreatectomy: does the laparoscopic approach protect patients from poor quality outcomes?

Baker MS, Sherman KL, Stocker S, Hayman AV, Bentrem DJ, Prinz RA, Talamonti MS.SourceDepartment of Surgery, NorthShore University Health Center, Walgreen's Building, 2nd Floor 2650 Ridge Avenue, Evanston, IL, 60201, USA, mbaker3@northshore.org.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.J Gastrointest Surg.2013 Feb;17(2):273-80. doi: 10.1007/s11605-012-2104-2. Epub 2012 Dec 6.
INTRODUCTION: Established systems for grading postoperative complications do not change the assigned grade when multiple interventions or readmissions are required to manage a complication. Studies using these systems may misrepresent outcomes for the surgical procedures being evaluated. We define a
PMID 23225109