TP / AIT

Pancreatectomy is the surgical removal of all or part of the pancreas. There are several types of pancreatectomy including:

  • Whipple Procedure (Pancreaticoduodenectomy) is performed to treat cancerous tumours on the head of the pancreas, malignant tumors involving common bile duct, duodenal papilla, duodenum near the pancreas, or pancreatitis with or without definitive cause (typically, though, the removal of pseudo-cysts from the head of the pancreas).
  • Puestow Procedure (Puestow-Gillesby procedure, or a pancreaticojejunostomy) is a procedure where the main pancreatic duct is opened longitudinally from the head to the tail of the pancreas. The pancreatic duct is then connected to the small intestine to allow the pancreas to drain directly into the intestines.
  • Frey’s Procedure (lateral Pancreaticojejunostomy) is a technique used where the diseased portions of the pancreas head are removed. A lateral pancreaticojejunostomy (LRLPJ) is performed. A portion of the jejunum is then attached over the exposed pancreatic duct to allow better drainage of the pancreas.
  • Distal Pancreatectomy is where the bottom half of the pancreas is removed by a surgical procedure. The most frequent reason for performing a distal pancreatectomy is the presence of a tumor in the body or tail of the pancreas.
  • Segmental Pancreatectomy is the limited resection of the midportion of the pancreas and can be performed in selected patients affected by tumors of the pancreatic neck.
  • Total Pancreatectomy (or TP) is the total and complete removal of the pancreas. TP is usually referred to with AIT or Auto Islet Transplantation. The pancreas has specialized clusters of cells that produce insulin. These specialized cells, called islets, can be "infused" into the liver so they continue to produce insulin. When a TP is performed, with or without AIT, digestive enzymes are a necessity. If the AIT is successful, there usually is no need for insulin injections (although that remains a possibility).

With or without an AIT, a TP has a success rate of 80% at eliminating the pains associated with AP / CP. The remaining 20%, or so, still report pains afterwards, though. I personally would consider a TP in these scenarios only:

  • pancreatic cancer
  • pancreas is necrotizing, which means it is dead and causing infections of other organs
  • pancreas is in severe necrosis, which means significant portions of the pancreas are necrotized
  • constant (100% of the time) and unyielding pain where pain medication is having no effect

I would not consider a TP for any other reason unless it can be proven that it is life threatening. I want to note that many doctors and hospitals promote Quality of Life as a criteria in elective TP. That is a personal choice. You need to consider a TP with your own personality and life criteria, as well as discuss this with your family and medical support team. Please do your research, this has to be a decision based not only on pain relief, but also on the possible complications of TP that include other organs that may be removed at the same time (spleen, gall bladder, common bile duct, portions of small intestine, and portions of stomach), enteral feeding, processing and digestion of food and the effects on blood glucose levels. A description of pancreatectomy and the risks is found on this medical encyclopedia page.

And as a note, I also would not consider removal of a gall blader ... no removals at all unless it is backed up by solid evidence that is necessary (life-threatening) to remove.

Autologous Islet Cell Transplantation (AIT) is a procedure to prevent diabetes or reduce the severity of diabetes after a pancreatectomy (TP). After pancreatectomy, insulin-producing islet cells are immediately isolated from the pancreas in a lab. These islet cells are then infused (transplanted) into the patient’s liver. The islet cells continue to produce insulin to control blood sugar levels in the body. According to the American Diabetes Association, less than 10% of those who have had the AIT procedure are still insulin independent at their five-year follow up. The average duration of insulin independence was 15 months.

The website (link above) also discusses mortality rates for TP and TP/AIT procedures. Please note that this is fairly low – 1.4% from complications related to the surgery.

Just as important, you also need to consider the survival rates. According to the US National Library of Medicine, the survival rate for TP/AIT is 16.6 years and the survival rate for TP is 12.9 years. They also report that the cost of the TP/AIT operation is relatively neutral when compared to the cost of no operation (over the same 16.6 year survival period).

Join The Discussion

pancreas