“Can individual live without pancreas?” The answer is yes. Pancreas is removed when individual is suffering with chronic repeated pancreatitis or pancreatic cancer. Most individual after total removal of pancreas for non-cancer disease live for several years when hormone and enzyme deficiency is corrected.1 Some suffering with cancer of pancreas may not survive after removal of entire pancreas for more than 7 years. In such cases spread of cancer of pancreas causes death and not from the complication of removal of pancreas. The long term survival depends on recovery from metabolic disorder and surgical complications that follows removal of pancreas. In most cases several metabolic and surgical complications are observed during the period immediately following removal of pancreas. Metabolic disorder is caused by lack of hormone and enzyme that is secreted by pancreas.
Pancreas secretes insulin hormone and several enzymes. Insulin is released in blood and controls blood glucose level. Enzymes are released through pancreatic duct into intestine. Enzymes are necessary to digest food within small intestine. The partial removal of pancreas causes partial deficiency of insulin and enzyme, while total removal of pancreas causes total deficiency of insulin and pancreatic enzyme. The surgical complications include infection, and non-healing surgical wound. The metabolic complications are observed when blood sugar level is extremely high resulting in hyperglycemia and metabolic acidosis. Metabolic disorder also observed when protein, fat and carbohydrate are not digested within intestine and absorbed in adequate amount. Lack of adequate insulin in blood and pancreatic enzymes in intestine causes serious metabolic disorder. In most of the cases metabolic disorder is prevented, when insulin and pancreatic enzymes are provided to individual who had removal of pancreas. Today, with the advancement in medical science, a person may live without his/her pancreas for several years when insulin and pancreatic enzymes are supplemented.
What Is The Function Of A Pancreas?
Pancreas in humans refers to a gland located in the abdominal area below the diaphragm and underneath the stomach. Its shape is like a big tadpole with circular head and a tapered thin body. Head of pancreas is enclosed and surrounded by “C” shape duodenum. Duodenum is the first part of small intestine that is attached to stomach.
Pancreas has two different types of endocrine cells that secretes exocrine enzyme and insulin hormone. The enzyme secreted by pancreas is carried through a pancreatic duct and discharged into small intestine. The enzymes are known as exocrine enzyme because enzyme is discharged into organ outside pancreas like intestine, though enzyme is produce by pancreas. Pancreas produces 1.5 to 2 liter of enzyme that is discharged outside pancreas into intestine lumen.2
Pancreatic Enzyme- Types of exocrine enzyme secreted by pancreas are as follows-
Enzyme Lipase- Lipase, when mixed with food in intestine, causes breakdown of fatty food to smaller particles. These digested fatty foods are then absorbed by intestine and transmitted by blood to liver and other organs.
Enzyme Proteases- The protease enzyme when mixed with semi digested food in intestine breaks the protein in smaller tiny molecules.
Enzyme Amylases- Breaks down carbohydrate to smaller molecule that is easy to absorb.
Insulin Hormone- Beta cells of pancreas secretes hormone known as insulin. Insulin is discharged into blood. The insulin secretion is triggered by blood glucose level. Higher blood glucose leads to higher insulin secretion and lower blood glucose level leads to none or lower insulin level.
Glucagon Hormone- Alpha cells of pancreas secrete glucagon hormone. Low blood sugar level in blood known as hypoglycemia stimulates alpha cells to secrete more glucagon. Glucagon then converts glycogen to glucose in liver. Thus the normal level of glucose is maintained.
Types of Pancreatectomy: Surgical Removal of Pancreas
Surgical procedure of removal of pancreas from human body is known as pancreatectomy. Pancreas is divided in 3 portions, known as head, body (middle 1/3rd portion) and tail. Pancreas is either partially removed (partial excision) or completely removed. Partial removal of pancreas is termed as partial pancreatectomy and removal of complete pancreas is known as total pancreatectomy.
Following Are The Surgical Procedure For Removal Of Pancreas:-
- Proximal Partial Pancreatectomy- Partial removal of proximal part of pancreas or head of pancreas is known as proximal partial pancreatectomy.
- Segmental Partial Pancreatectomy- Removal of middle portion of pancreas is known as segmental pancreatectomy.
- Distal Pancreatectomy- Removal of tail of pancreas or distal end of pancreas is known as distal pancreatectomy.
- Total Pancreatectomy- Total removal of pancreas is known as total pancreatectomy.
How Long Can You Live Without A Pancreas?
The number of year that a patient can live without a pancreas depends on tolerance to external supplement of insulin and enzymes. Individual following surgery is given external insulin hormone injection and oral pills of enzymes to replace the deficiency of hormone and enzyme. Insulin dosage is titrated to maintain blood sugar level within normal range. Similarly, oral enzymes are given to support digestion of protein, fat and carbohydrate in intestine. Individual then can maintain a normal healthy lifestyle by taking these medications and diet control. Individual suffering with partial or total pancreatectomy may need periodic adjustment of dosage of insulin and pancreatic enzyme.
The regular monitoring of blood levels of fat, protein and glucose is essential to titrate dosage of insulin and pancreatic enzyme. The frequent examination of blood level of hormone and enzyme is performed in patients who had total pancreatectomy to titrate insulin and other enzyme dosage. The long time survival of patients without pancreas depends on regular monitoring of vital signs, blood examination, prevent metabolic acidosis, prevent infection, prevent low or high blood sugar level, taking insulin injection as advised and taking hormone as prescribed. Symptoms of metabolic disorder are uncommon if blood sugar level is maintained near normal and diabetes is controlled with insulin.2
The long term survival also depends on side effects and complication following extensive surgery. In few cases removal of stomach, gall bladder, intestine and spleen is necessary when malignant pancreatic cancer has spread to adjacent organs. In such cases, prognosis or long term outcome depends on surgical complications as well as lack of physiological function because of removal of these organs. Individual can live normal healthy life for long time when pancreas is removed for non-cancer diseases. Most patient who had total pancreatectomy for cancer of pancreas often live up to 7 years or less.3
Living After Total Pancreatectomy Surgery
The scientific published data suggests over 50% patient survive over 7 years after total pancreatectomy performed for cancer of pancreas and over 75% patient survive for over 7 years when pancreas is removed for non-cancer diseases.2 Overall in recent year 50% of patient had survived for over several years after removal of total pancreas for cancer as well as non-cancer diseases. After total pancreatectomy surgery, while taking supplemental medications you have to make the necessary changes in your diet and lifestyle. Over 50% of individual had return to work after partial pancreatectomy.4
Monitor Blood Sugar Level and Insulin Dosage
Normal pancreas produces insulin immediately after intake of food. The increased level of sugar in blood following breakfast, lunch and dinner stimulates beta cells of pancreas to secrete insulin. Partial pancreatectomy results in removal of part of the pancreas. Remaining normal pancreas that is left behind is then able to secrete insulin. The amount of insulin secreted may be not enough and individual need external insulin. In that case blood sugar need to be maintain to normal level by periodic injection in insulin. The published data suggests 19.2% patients suffer with pancreatic diabetes after partial pancreatectomy.5 Most of these patients were obese. The mortality (death rate) is high after total pancreatectomy in patient suffering with pancreatic cancer. The reason was more of cancer complication than diabetic metabolic disorder. The patients who survived after extensive surgery need careful monitoring of blood glucose level to prevent metabolic disorder and maintain blood sugar to normal level.5
The insulin units to be administered to control blood sugar depends on blood sugar level and daily quantity of carbohydrate consumed. Your doctor will advise you to eat several small number of meals in a day to avoid any huge spike in your blood sugar levels. In addition to this you are also advised to avoid alcohol, ice cream and chocolates. On the other side, you are also advised to carry appropriate glucose source, while traveling and taking periodic insulin injection. Insulin injection causes hypoglycemia if sugar intake is inadequate. So to prevent hypoglycemia that may cause severe attack of fainting and dizziness one must carry biscuits or some carbohydrate or sugar containing food.
Intake of Enzyme Replacement Pills
Pancreatic enzymes are partially or completely depleted when individual is treated with partial or total pancreatectomy. Hence, you have to supplement external digestive enzymes with each of your meals to make sure there is adequate enzymes available in intestine to digest food. Thus, doctors recommend you to take an enzyme replacement pill with your meals. There are various enzyme mix therapies available. The Pancrelipase is an enteric coated microsphere (ECM) that has been used as enzyme supplement.7 After partial pancreatectomy 80% of patients do suffer with pancreatic enzyme insufficiency, and following total pancreatectomy 100% patients need pancreatic enzyme supplements.
Diet Control and Physical Exercise are Essential
If your aim is to stay healthy for a long time, even after total pancreatectomy surgery, then you have to follow a diabetic diet plan and perform exercise that you can tolerate. This means, you have to avoid heavy carbohydrate diet that includes rice, pasta, bread, chocolates, ice creams and sweet food. Individual suffering with pancreatic hormone and enzyme deficiency must make an attempt to keep blood sugar and blood pressure near normal level. Eat healthy food that includes vegetables, fruits, grains, meat, fish, eggs, nuts and beans.7 Dairy products like yogurt and cheese can be added to daily meal. Same time you must avoid low blood sugar level known as hypoglycemia. Individual suffering with pancreatic enzyme deficiency must consult gastroenterologist and dietitian for diet recommendation. The weekly exercise must be charted depending on tolerance to exercise.
Diabetes diet, Eating, & Physical activity
- Patient outcomes after total pancreatectomy: a single center contemporary experience John A Stauffer,1 Justin H Nguyen,2 Michael G Heckman,4 Manpreet S Grewal,1 Marjorie Dougherty,2Kanwar R S Gill,3 Laith H Jamil,3 Daniela Scimeca,3 Massimo Raimondo,3 C Daniel Smith,1 J Kirk Martin,1 andHoracio J Asbun1 , HPB (Oxford). 2009 Sep; 11(6): 483–492.
- Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center Hazem M Zakaria, John A Stauffer, Massimo Raimondo, Timothy A Woodward, Michael B Wallace, and Horacio J Asbun, World J Gastrointest Surg. 2016 Sep 27; 8(9): 634–642.
- Long-Term Results of Distal Pancreatectomy for Chronic Pancreatitis in 90 Patients Robert R. Hutchins, MS, FRCS,* Richard S. Hart, MD, FRCSC,* Marc Pacifico, MRCS,* Nicholas J. Bradley, MSc,†and Robin C. N. Williamson, MD, FRCS*, Ann Surg. 2002 Nov; 236(5): 612–618.
- Pancreatic Diabetes after Distal Pancreatectomy: Incidence Rate and Risk Factors Ka-Jeong Kim, M.D., Chi-Young Jeong, M.D., Sang-Ho Jeong, M.D., Young-Tae Ju, M.D., Eun-Jung Jung, M.D.,Young-Joon Lee, M.D., Sang-Kyung Choi, M.D., Woo-song Ha, M.D., Soon-Tae Park, M.D., and Soon-Chan Hong, M.D., Korean J Hepatobiliary Pancreat Surg. 2011 May; 15(2): 123–127.
- How severe is diabetes after total pancreatectomy? A case-matched analysis Keith J Roberts,1 Georgina Blanco,1 Jonathan Webber,2 Ravi Marudanayagam,1 Robert P Sutcliffe,1Paolo Muiesan,1 Simon R Bramhall,1 John Isaac,1 and Darius F Mirza1, HPB (Oxford). 2014 Sep; 16(9): 814–821.
- Pancreatic enzyme replacement therapy in post-pancreatectomy patients. Braga M1, Cristallo M, De Franchis R, Mangiagalli A, Zerbi A, Agape D, Primignani M, Di Carlo V., Int J Pancreatol. 1989;5 Suppl:37-44.
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