Pancreas

What is the pancreas?

The pancreas is a complex organ located deep in the abdomen that has many functions. It produces digestive enzymes, which drain through the pancreatic duct into the duodenum, which is the first part of the small intestine. Although this portion of the pancreas (the exocrine portion) can develop benign or malignant tumors, they are not specifically discussed here. The pancreas also has specialized cells which produce a number of endocrine hormones. The information to follow concentrates mostly on this "endocrine pancreas."

Only about 5% of the mass of the pancreas is composed of endocrine cells which are also called "islet cells" since they are clustered together like small islands. These cells secrete important hormones into the bloodstream. Some of these hormones are insulin, glucagon, gastrin, and vasoactive intestinal peptide (VIP).

When is endocrine pancreatic surgery needed?

If a tumor of these islet cells occurs, it may overproduce one or more of these hormones. These tumors are often named by their hormone plus the suffix "oma." Therefore, an insulinoma overproduces insulin and will cause low blood sugar (hypoglycemia). A glucagonoma overproduces glucagon and will cause high blood sugar (diabetes) and characteristic skin changes. A gastrinoma secretes gastrin and may cause excess stomach acid secretion, ulcers, and diarrhea. A VIPoma is a very rare tumor which secretes vasoactive intestinal peptide and causes a high-volume watery diarrhea with electrolyte imbalances.

Even very small tumors less than 1 cm in size can cause serious problems related to their hormone production. Depending on the type of tumor cells, they may also be likely to behave in a malignant fashion (spreading as a cancerous growth). These are the important indications for having endocrine pancreatic surgery.

How is endocrine pancreatic surgery usually performed?

Operations on the pancreas typically require an abdominal incision with some dissection of the stomach and intestines to expose the pancreas located deep within the abdomen. Many of these endocrine tumors may be dissected out of the substance of the pancreas, but in some cases may require partial removal of the pancreas (pancreatectomy). Some of these operations can be performed using a laparoscope.