The inflammation of pancreas in a short period of time indicates acute pancreatitis. The most common symptom is a sudden onset severe upper abdominal pain which goes to the back and is usually associated with nausea and or vomiting. In this situation, you must immediately consult a team specializingin treatment for this disease if feasible. Appropriate early management by a specialized team helps reduce subsequent complications and helps improve outcomes.
Heavy alcohol use and gallstones are risk factors for pancreatitis, and pancreatitis is a risk factor for pseudocysts. Pseudocysts are not cancerous (benign). Most pseudocysts are asymptomatic and remain stable or show spontaneous resolution. However, surgery might be needed to treat large pseudocysts, or those associated with symptoms or complications causing severe abdominal pain, vomiting or poor oral intake. We routinely perform laparoscopic treatment of pseudocysts with very good outcomes.
In a patient with acute pancreatitis, infected necrosis is a serious development often associated with complications and may require surgical treatment at the right stage. I perform minimally invasive necrosectomy by placing a nephroscope in the necrotic tissue cavity using a percutaneous approach, and remove the necrotic material using irrigation, snares, and/or baskets. Less often, I prefer performing an open necrosectomy procedure especially in patients with multiorgan dysfunction syndrome associated with pancreatitis. Besides the smaller incisions, the major and much moreimportant advantages are relatively lesser need for ICU stay, earlier recovery and lesser collateral damage to surrounding structures.
Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to a permanent change with impaired functioning of the pancreas. Chronic pancreatitis eventually impairs a patient's ability to digest food and make pancreatic hormones. Surgery is able to provide durable pain relief in those not responding to medication alone and simultaneously address the associated complications (biliary obstruction, pancreatic fistulae, and inflammatory head mass) that may arise following chronic pancreatitis. Timely treatment including surgery in experienced hands leads to good outcomes with complete relief in symptoms with significant improvement in pancreatic function as well.
A cancer that develops within the pancreas falls into two major categories: (1) cancers of the endocrine pancreas (the part that makes insulin and other hormones) are called "islet cell" or "pancreatic neuroendocrine tumors or PNETs". Islet cell cancers are rare and typically grow slowly. Islet cell tumors often release hormones into the bloodstream and are further characterized by the hormones they produce (insulin, glucagon, gastrin, and other hormones). and (2) Cancers of the exocrine pancreas (the part that makes enzymes). These are more common and dangerous as they usually remain asymptomatic till late stages of spread of disease.
Surgery is the only potentially curative treatment for pancreatic cancer. The surgical procedure most commonly performed to remove a pancreatic cancer is a Whipple procedure (pancreatoduodenectomy) or a more refined procedure called pylorus preserving pancreaticoduodenectomy which we specialize in. The latter procedure has the advantage of preserving the entire stomach resulting in ability to take full meals (due to preservation of reservoir capacity of stomach), and also its function (aiding Vitamin B12, iron and calcium absorption). It often comprises removal of a portion of the stomach, the duodenum (the first part of the small intestine), pancreas, and a portion of the main bile duct, lymph nodes, and gallbladder. Unfortunately, some patients have pancreatic tumours that are too locally advanced to completely remove or have metastatic spread at the time of diagnosis. Even these patients, with help of multimodality treatment comprising chemotherapy, surgery and if needed radiotherapy, have a good chance at cure.
All pancreatic masses do not represent pancreatic cancer or all inflammatory pancreatic cysts do not represent pseudocyst of pancreas. They include serous cystadenoma, mucinous cystadenoma, intraductal papillary neoplasm etc. Most of these benign tumors of the pancreas have an excellent prognosis when treated surgically. The choice of surgical procedure depends on the location of the lesion in the pancreas. For tumours of the head of the pancreas, a Whipple’s pancreaticoduodenectomy or pylorus preserving pancreaticoduodenectomy is required. For lesions in the body and tail of pancreas a laparoscopic or open distal pancreatectomy is done.