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Dr. George S. Ferzli, M.D. F.A.C.S.
65 Cromwell Avenue
Staten Island, NY

Pancreas Surgery

The pancreas sits behind the stomach with its head nestled in the loop of the duodenum and its tail extending to touch the spleen.
It functions as an exocrine gland, releasing digestive enzymes and sodium bicarbonate to aid in digestion. As an endocrine gland, it makes many hormones, including insulin. Diabetes mellitus will result if the pancreas cannot make an adequate amount of insulin.

Pancreatitis
The pancreas can become inflamed acutely causing abdominal pain. In the U.S., 65% of cases of acute pancreatitis are caused by alcoholism. The next major cause is biliary tract disease which may require surgery to relieve an obstruction caused by gallstones.
Chronic pancreatitis most commonly occurs in alcoholics. Prolonged inflammation causes damage and eventual fibrosis (scarring). Pancreatic secretions may pool in pockets called pseudocysts. These cysts can be very painful or may cause other symptoms like difficulty with eating and even obstruction of the flow of food out of the stomach. Surgery may be necessary to clear obstructions or other complications resulting from pancreatic pseudocysts.

Pancreatic cancer
Adenocarcinoma of the pancreas is cancer of the pancreatic duct. It is the fifth leading cause of death in the U.S. It is diagnosed in about 30,000 people in the U.S. every year. Early diagnosis is difficult since few symptoms are present until it has spread to the liver, intestine or elsewhere. While little is known about its cause, the strongest environmental factor is smoking. Pancreatic cancer seems to have a genetic component, as it seems to run in some families. Former President Carter’s mother, brother and sister all developed this form of cancer.

The only way to cure pancreatic cancer is with surgery. Surgery for pancreatic cancer is indicated when the cancer has not spread beyond the pancreas. A tumor at the tail of the pancreas may require removal of only the pancreatic tail. Tumors of the head of the pancreas require an extensive operation called the Whipple Procedure. A Whipple is also known as a pancreaticoduodenectomy. In a Whipple, the tumor is removed with the head of the pancreas, as well as with part of the stomach, part of the duodenum (first part of the small intestine) the gall bladder and the common bile duct (part of the drainage duct of the liver). After recovery, most patients require some form of chemotherapy.

Pancreatic endocrine tumors
Tumors of the endocrine cells of the pancreas can also form. These are cancers of he pancreatic tissue that produces hormones. Often these are benign tumors, but they can produce excess hormones and cause severe symptoms.
These other pancreatic neoplasms include:
Insulinomas – insulin producing tumors that can cause very low blood sugar.
Gastrinomas – gastrin producing tumors that can drastically increase the acid production of the stomach causing stomach ulcers.
Glucagonomas – glucagon producing tumors that results in mild diabetes and skin rash.
VIPomas – vasoactive intestinal polypeptide (VIP) producing tumors that result in diarrhea, and fluid and electrolyte problems.

For further information, you can ask Dr. Ferzli.