The pancreas in Greek  means a ‘pound of flesh’ and has been described in ancient Ayurvedic texts as well as by Aristotle in his teachings. The organs’ functions were however shrouded in mystery till in the late 18th century when its removal was noted to result in development of diabetes in dogs.

The pancreas is about 6 inches long and sits across the back of the abdomen, behind the stomach. Because of the deep location of the pancreas, tumors of the pancreas are rarely palpable (able to be felt by pressing on the abdomen). This explains why most symptoms of pancreatic cancer do not appear until the tumor has grown large enough to interfere with the function of the pancreas or other nearby organs such as the stomach, duodenum, liver, or gallbladder.

The pancreas is a critical organ for the digestive system as well as the endocrine system. It has a dual function.The digestive cells within the pancreas produce digestive juices which drain via the pancreatic duct into the intestine. These juices are especially important in the breakdown and digestion of protein and fats in our diet.The other endocrine part of the pancreas produces hormones like insulin and glucagon and secrete them into the blood stream to finely regulate our blood sugar levels.Thus diseases of the pancreas can manifest with both endocrine as well as digestive symptoms like sudden onset of diabetes , weight loss , pain in the abdomen radiating to the back jaundice and fatty stools , bloody stools etc.

We will discuss 2 of the most common diseases we encounter that may require surgery

Chronic Pancreatitis-

It is a disease of the pancreas that results from long term damage by inflammation characterised by calcium deposits or stones seen on imaging. The damage may be due to alcohol intake which is the commonest reason seen worldwide. Or it can be a combination of unknown environmental and genetic  factors . The alcoholic type manifests usually in middle age with pain , calcium deposits in pancreas and diabetes. Occasionally malignancy may arise. However in another common variant called 'tropical pancreatitis' it manifests at a much younger age and progresses much faster to diabetes and sometimes cancer. 

Treatment is aimed mainly at relieving symptoms of pain, enzyme supplements for the digestive enzyme deficiency and insulin for the diabetes. Patients must remain on regular follow up.

Surgery is performed only when medicines for pain are ineffective or when there is a suspicion that malignancy has developed. It is usually a procedure where the pancreas is opened and stones are removed and the suspicious area of malignancy or the main pain producing part of the pancreas is removed and remaining areas joined back to the intestines. After successful surgery upto 80 % of patients remain symptom free.

Pancreatic cancer

Can be of many types but Adenocarcinoma is the commonest variety . As mentioned earlier due to the deep location of the pancreas symptoms may be hidden for a long time before they appear , so the malignancy may be advanced. Some special variants like the periampullary type appear earlier and thus have better results.The treatment is surgery alone as chemotherapy is generally ineffective. Even in advanced stages with major vein involvement surgery still holds the best chance for cure.

Dr Bejoy Abraham

Consultant Gastrosurgeon