Can you live without the pancreas?

The pancreas plays an important role in digestion and blood sugar control. Unfortunately, if it becomes affected by cysts or cancer, part or all of the pancreas may need to be removed. So can you live with only a part of your pancreas, or no pancreas at all? We asked internationally renowned professor of liver and pancreas surgery, Professor Hemant Kocher. of the University of London:

What is the role of the pancreas?

The pancreas has two main roles. For ease of understanding, the pancreas is divided into exocrine pancreas and endocrine pancreas. However, in the real human pancreas the endocrine pancreas is small (approximately 1% in weight or volume) and is interspersed within the exocrine pancreas.

The endocrine pancreas pumps chemicals called hormones into the blood stream.

The exocrine pancreas performs the function of digestion of food by pumping digestive enzymes into the bowel. Digestive enzymes are chemicals which break down the food we eat into smaller molecules. The stomach and small bowel send signals to the pancreas when these enzymes are needed. As a result of the signal, the pancreas immediately releases stores of pre-manufactured enzymes into the bowel. Digestion then takes place in small bowel over next two-three hours.

The enzymes are necessary to help us absorb nutrients to give the human body the materials it needs for energy, building muscle and normal working. There are specific enzymes to digest protein, fat, carbohydrates and other nutrients. If we did not have pancreass, all the food we eat would pass straight through. As a result, a person would have steatorrhea.

Steatorrhea is a specific type of loose motion or diarrhoea where particularly undigested food comes straight through. It can have a lot of fat in it, as there is no other part of digestive tract which produces fat breaking enzymes. Consequently, fat remains floating in toilet-pan, and is difficult to flush. There are many causes of steatorrhea, and it needs to diagnosed and managed by a specialist doctor. Treatment is relatively straightforward, but should be taken under supervision of a specialist pancreas doctor.

The endocrine pancreas is very important too. It is called endocrine because it releases chemicals directly into blood stream. There are many functions of the endocrine pancreas, but the most commonly-known and understood is maintaining glucose levels. If the endocrine pancreas is not functioning well, then you can develop diabetes. There are many types of diabetes, and treatment should take place under guidance of a diabetes specialist.

What are the different types of diseases that could affect the pancreas?

Diabetes is the most common illness which affects the pancreas. Some types of diabetes are as a result of endocrine pancreas not working properly, whilst other types are due to problems in other parts of body and rarely due to medications used to treat other diseases. Diabetes is treated by specialist diabetes doctors.

The pancreas can also get inflamed due to irritation from a variety of agents. This is called pancreatitis. This is also fairly common. There are many types of pancreatitis depending on the causative agent and the duration of the problem. Gallstones and alcohol are the commonest causes of pancreatitis. Pancreatitis can be life-threatening in some cases, and should be treated by either surgeons or physicians specialised in treating this condition.

Pancreatic cancer is more frequently diagnosed such that it is likely to be the second commonest cause of cancer-related death in the Western World. There are many types of pancreatic cancers. The diagnosis and treatment of pancreas cancer is done in multi-disciplinary teams of specialist doctors such as surgeons, gastroenterologists and oncologists.

Pancreatic cysts are increasingly being found as a result of increased use of scans such as ultrasound, CT scan and MRI scans. When found these have to be assessed and monitored as some of these cysts can be pre-cancerous.

When would the pancreas need to be removed?

The pancreas is usually removed partially. It is rare that surgeons perform a total pancreas removal. Removal of (part of) the pancreas is commonly performed for:

• pancreatic cancer
• pre-cancerous pancreatic cysts
• chronic pancreatitis.

Surgery for the pancreas is one of the most complex operations because the pancreas is intimately connected to a number of digestive organs. It is further complicated by the fact that the pancreas sits on top of and around vital blood vessels in the upper part of tummy. Because of this, pancreas surgery is carried out by making a big cut on the tummy.

Increasingly, surgeons are trying to develop techniques to perform operation on the pancreas using key-hole (laparoscopic) surgery or robotic surgery. These methods have not been proven to be superior to an open operation.

An operation on the pancreas generally results in hospital stay of 1-2 weeks, and it may take 6-8 weeks to regain normal activity. This depends on the type of operation carried out.

How does the body function without the pancreas?

Most often only part of pancreas is removed. In these situation the body and the pancreas adjusts to the loss of the removed pancreas. Most often (>60%) of times with removal of half the pancreas, the person sees no difference in exocrine or endocrine pancreas.

However, sometimes after removal of part of the pancreas the patient may become diabetic or any pre-existing diabetes may worsen (problems due to loss of endocrine pancreas). This would require careful monitoring and treatment. Patients may also develop digestive problems (problems due to loss of exocrine pancreas). This can be also easily treated by taking tablets.

Total removal of the pancreas requires very careful medical treatment and close monitoring by a specialist. With medications, many such patients can achieve good quality of life and sometimes normal function and work. Pancreas transplants are sometimes done when either the existing pancreas is not working (diabetes) or the whole pancreas is removed for chronic pancreatitis or other conditions.

Can you live a normal life without the pancreas?

Life without pancreas requires careful medical monitoring and life-long treatment. There are no long-term studies on patients who have no pancreas left, but from experience patients go on to have normal life expectancy with careful medical supervision.