Download Pancreas Information Brochure

Upper Gastrointestinal Surgical Unit
PATIENT INFORMATION:PANCREAS
Clinical Associate Professor Jas Samra
Royal North Shore and North Shore
Private Hospitals
CANCER OF THE PANCREAS
Cancer of the Pancreas is commonly found in the head of the pan-
PEOPLE TO CONTACT IF YOU HAVE PROBLEMS:
creas. These patients often present with jaundice (yellowness of skin
and eyes, dark urine). If the disease is confined to the head of the
pancreas then surgery is the best option. The procedure required to
Your Consultant: Dr. Jas Samra Ph: (02) 94363775
resect the tumour is called a Whipples procedure, named after Prof
Nancy Consoli
Alan Oldfather Whipple.
Cancer Nurse Coordinator
The Whipples procedure is also performed for pre-malignant tumours
Phone: 9926 6484
of the head of the pancreas, tumours of the distal part of the bile duct
Mobile: 0404 830 599
and of the Ampulla (the junction of the common bile duct and pancreatic duct where it all comes into the bowel).
When the tumour is confined to the body or tail of the pancreas then
a Distal Pancreatectomy is carried out. Occasionally a tumour can
The Ward at RNSH: 11A - 99268110
10B - 99268022
involve both the head and the tail and in those rare cases the whole
of the pancreas is removed and the procedure is called a total pan-
North Shore Private Hospital, Level 5 : 84253540
createctomy.
WHIPPLE’S OPERATION
Your General Practitioner
PLEASE GO TO YOUR NEAREST HOSPITAL EMERGENCY
DEPARTMENT IF YOU REQUIRE URGENT MEDICAL ATTENTION AFTER HOURS.
This diagram shows what is removed
This diagram shows after the surgery
how everything is joined together
Whipple’s operation is a major procedure. It is also known as a
Driving: Do not drive for approximately 6 weeks post surgery. If it
Pancreatico-duodenectomy. It entails removal of the very last part
is necessary to drive before hand, only drive very short distances.
of the stomach, the head of the pancreas, the duodenum, common
Work: You will generally be able to return to work approximately
4 - 6 weeks post surgery, if your work does not involve heavy lifting. You may only feel like doing half days at first when returning
to work. Try not to over do it. Your body needs some time to heal.
Follow up: You will be required to see your Pancreatic surgeon
4 - 6 weeks after discharge from hospital. An appointment should
be made for you before discharge. If it is not please phone your
surgeons secretary to arrange one. You will not require a blood
test or CT scan prior to this appointment unless otherwise specified by your Surgeon/CNC.
Symptoms to Report to your treating team immediately:
 Severe Pain
 High Temperatures
bile duct and gallbladder. Occasionally, the vein that runs through
the neck of the pancreas is involved with the tumour and part of this
has to be resected along with the head of the pancreas. This procedure previously had a mortality (chance of dying from the operation
of 10-15%). Currently, it stands at less than 3%. However, 40% of
patients will get one or more complications.
Pancreatic Fistula - The commonest complication post op is
where the cut end of the pancreas is joined to the bowel; it can
leak. This is called a pancreatic fistula. The incidence of pancreatic
fistula varies between 4-10%. If the pancreatic juice continues to
leak, it is liable to cause secondary problems in the form of bleeding. Therefore, it is imperative that pancreatic fistulas are managed
aggressively.
Delayed Gastric Emptying - DGE. Up to 10% of patients will experience this complication. It implies that the stomach does not
 Signs of Urinary Infection such as high temperatures, unpleas
empty well. As a result the patient is unable to keep food down.
ant smelling urine or burning sensation when urinating.
Therefore, the patient will require nutrition through the vein. 80% of
 Increased shortness of breath or increased swelling of your
lower limbs.
 Signs of wound infection such as redness, heat or discharge
from around the wound.
the patients will settle down in the first week. Of the remainder of
the patients a further 80% will settle down the following week.
Bleeding - There are major vessels around the pancreas and pancreatic head. Bleeding can occur in the early phase due to a technical problem or delayed phase, secondary to a pancreatic fistula.
Early bleeding is controlled by re-operation and tying the bleeding
vessel. Late bleeding is controlled by radiological intervention
where a small tube is inserted into the artery, dye is injected, the
leakage is then identified and blocked from the inside.
Abdominal Abscess - 4-6% of patients will collect a small amount
of fluid on the inside which may become infected. It is inevitable
that most people will have a fluid collection post op, however a vast
majority will not become infected. If it becomes infected the patient
will experience a high temperature which normally swings. In that
event, the patient will require CT guided drainage of the collection.
Other complications such as electrolyte imbalance (salts in the
blood), infection of the urine and chest infection are very common.
Patients are encouraged to mobilise early, have more frequent
meals which are relatively small. It can often take up to 3 months to
recover from this procedure.
DISTAL PANCREATECTOMY
This operation entails the removal of the neck, body and tail of the
pancreas. If the tumour is very close to the splenic artery or vein,
(these two vessels run through the pancreas), then it is essential
that the spleen is resected with the tail of the pancreas. If the
spleen is resected along with the tail of the pancreas, patients will
require vaccinations as the spleen protects humans from certain
types of infections. The distal part of the pancreas can be resected
laparoscopically or open. This depends on the size of the tumour
and the adjacent organ involvement. The mortality associated with
this procedure is very low; less than 1%, however 10-15% of
Dietary Issues: It is very common to experience some further
weight loss post discharge from hospital. This may continue for a
few weeks but then should begin to stabilise. You may find that you
suffer from some taste changes and continue to have a poor appetite post your pancreatic surgery. Eating five small meals rather
than three main meals daily will help to combat this issue.
It is very important in order to assist your recovery that you maintain an adequate nutritional status. There are supplementary products such as Sustagen/Resource which are available to assist you
in achieving this, as well as many others should you find these are
not easy to tolerate. If you continue to struggle with your appetite
and weight loss post discharge please contact your Cancer Nurse
Co-ordinator who can assist you. Outpatient Dietician follow-up is
also easily available.
Bowel Issues: You may find constipation or persistent diarrhoea
(particularly after eating) are a problem post surgery. If this is the
case please ask your Cancer Nurse Co-ordinator for advise.
Wound Care: Wash your incision in the shower with soap and water. Do not rub the wound. You should not require a dressing on
your wound by the time you are discharged from hospital. Watch
wound for signs of infection - redness, heat or discharge from the
wound. Contact your GP or Surgeon/CNC if you notice any of
these signs.
Exercise: Gentle daily exercise is recommended, walking is perfect. Stop or rest when you have pain or feel tired, your body will
tell you when you have done enough.
TED Stockings: Wear your TED stockings (if you can tolerate
them) for 4 weeks post discharge from hospital. This will help reduce the risk of developing a DVT post surgery.
A physiotherapist will see you each day to help you to mobilise and
a dietician will aid you in maintaining adequate nutrition .
Before being discharged patients will be able to eat and drink relatively normally, albeit smaller meals. They will be able to move independently, however, there exercise capacity will be limited. It is
normal to feel weak and tired but these symptoms will improve
every day post your surgery.
Although everyone recovers differently, it is generally advised that
you have someone at home with you for the first couple of weeks
after discharge from hospital to assist you with all the daily activities of living.
If you do not have someone available to you to assist or you feel
apprehensive about returning home immediately after discharge
from hospital then please mention your concern to your Cancer
Nurse Co-ordinator prior to your admission or otherwise the nursing staff looking after you in hospital. Respite facilities can be arranged for you as a stepping stone between discharge from hospital and home.
POST OPERATIVE RECOVERY:
You have had a major operation and as previously mentioned it will
take sometime to fully recover and get back to how you were before the operation.
Medications: Please take your medications as directed by your
doctor. It is normal to experience mild post op pain and some analgesia will be required.
patients will get leakage of pancreatic juice from the cut end of the
pancreas. Therefore, a drain is left close to the cut end of the pancreas and panceatic juice is measured on Day 3,4 and 5. If there is
no juice detected in the fluid then one can assume there is no pancreatic fistula. Drains are then removed.
The tail of the pancreas is often removed not only for cancer but
also for pre-cancerous lesions, as well as Neuroendocrine type tumours.
WHAT YOU CAN EXPECT AFTER SURGERY
The majority of patients who undergo pancreatic surgery will be admitted on the day of surgery. Surgery can take somewhere between
3-7 hours. Patients will often be sent to Intensive Care and will only
return to the ward once the Intensivist is happy. On average, most
patients will spend 12-24 hours in Intensive Care.
If the patient has had a Whipples procedure then it is likely that patient will stay in hospital for between 10 -14 days, whereas in the
event of a Distal Pancreatectomy, patients will often stay between 5
-7 days.
After a Whipples procedure you will not be allowed to eat or drink.
When there are bowel sounds and you are passing wind, generally
approximately 5-6 days post surgery, you will start slowly back on
liquids and then food. Intravenous fluids will keep you hydrated in
the meantime.
Once commenced on full diet you may need to take pancreatic enzyme supplements for a period of time post surgery to assist your
body in the breakdown of food. This will be discussed with you if
necessary whilst you are in hospital.