The pancreas is an organ roughly the shape and size of a medium carrot that lies deep in the upper abdomen. It has two major roles:

• Production of hormones such as insulin (which regulates blood sugar levels)
• Production of a juice containing enzymes that helps digest food

Distal pancreatectomy is performed for cancers of the body or tail of the pancreas. The operation is also performed for some pancreatic neuroendocrine tumours and cysts of the pancreas that are at high risk of developing into cancer.

Distal pancreatectomy involves involves removal of the tail of the pancreas (and sometimes the body depending on the tumour location) and often the spleen. In some cases, it is possible to preserve the spleen when removing the distal pancreas. However, the spleen needs to be removed for cancers (in order to remove the lymph glands that lie between the pancreas and the spleen as these may contain cancer cells) or when the blood supply to the spleen must be removed due to the location of the tumour or cyst.

Distal pancreatectomy is often performed laparoscopically however in some cases, particularly for larger cancers, the operation needs to be performed as an open operation (through a single larger incision).

Complications of distal pancreatectomy include:

• Bleeding
• Leak of pancreatic juice (pancreatic fistula)
• Delayed gastric emptying (slow return of the stomach’s ability to digest food and empty)
• Diabetes (or worsening of diabetes if already diabetic)
• Malabsorption (due to insufficient pancreatic enzymes to digest food)

Other risks include general risks of major surgery such as blood clots in the legs (deep venous thrombosis) that can travel to the lungs (pulmonary embolism), infections and cardiac and respiratory problems.

If the spleen is removed there is a small risk (throughout life) of developing life-threatening infection due to a reduced ability to fight infections. This is known as OPSI (overwhelming post splenectomy infection). Adult patients who have had their spleen removed must take a low dose antibiotic for the first 2-3 years after surgery and be vaccinated against Pneumococcus, Haemophilus influenzae B and Meningococcus and have the annual flu vaccine. With these precautions the risk is low. More information is available on the Spleen Australia website at www.spleen.org.au

Most patients stay in hospital 4-5 days after distal pancreatectomy, although patients who have open surgery usually stay a little longer.