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surgical removal of part or all of the pancreas

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/10 22:06:07」(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.

Diagram showing how the bowel is joined back together after a total pancreatectomy

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.

External links

The Toronto Video Atlas of Liver, Pancreas and Transplant Surgery – Video of total pancreatectomy procedure

UpToDate Contents

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1. 膵体および膵体尾部病変の外科的切除 surgical resection of lesions of the body and tail of the pancreas
2. 膵外分泌癌の治療における外科手術の概要 overview of surgery in the treatment of exocrine pancreatic cancer and prognosis
3. Surgical resection of sporadic pancreatic neuroendocrine tumors
4. 膵体頭部病変の外科的切除 surgical resection of lesions of the head of the pancreas
5. 慢性膵炎の治療 treatment of chronic pancreatitis

English Journal

Validity of animal models of type 1 diabetes, and strategies to enhance their utility in translational research.

Graham ML1, Schuurman HJ2.
European journal of pharmacology.Eur J Pharmacol.2015 Jul 15;759:221-30. doi: 10.1016/j.ejphar.2015.02.054. Epub 2015 Mar 24.
Type 1 diabetes currently affects 20-40 million people worldwide. Insulin treatment is standard, but a majority of patients still experience glycemic instability and associated comorbidity: there is an unmet medical need for novel therapeutics. Animal models have been indispensable in testing innova
PMID 25814249

Circumportal pancreas: a review of the literature and image findings.

Connelly TM1, Sakala M, Tappouni R.
Surgical and radiologic anatomy : SRA.Surg Radiol Anat.2015 Jul;37(5):431-7. doi: 10.1007/s00276-015-1436-5. Epub 2015 Jan 28.
PURPOSE: Fused pancreatic tissue encasing the portal and/or superior mesenteric vein, circumportal pancreas, is a congenital anomaly that has been associated with operative complications in resections involving the head of the pancreas. We describe this anomaly and highlight its pathophysiology and
PMID 25626884

Pancreatic adenocarcinoma with venous involvement: is up-front synchronous portal-superior mesenteric vein resection still justified? A survey of the association française de chirurgie.

Delpero JR1, Boher JM, Sauvanet A, Le Treut YP, Sa-Cunha A, Mabrut JY, Chiche L, Turrini O, Bachellier P, Paye F.
Annals of surgical oncology.Ann Surg Oncol.2015 Jun;22(6):1874-83. doi: 10.1245/s10434-014-4304-3. Epub 2015 Feb 10.
BACKGROUND: Venous resection (VR) during pancreatectomy has been reported to neither increase mortality nor morbidity and to provide similar survival outcomes in same stage tumors. However, controversy remains regarding the indications for up-front surgery according to the degree of venous involveme
PMID 25665947