Blog de Cirugía del Páncreas

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Blog de Cirugía del Páncreas

13 January, 2022

What is the pancreas, what function does it have and what diseases can it develop?

The pancreas is a fundamental organ for the digestion of food. It is a gland that makes up part of the digestive system that has a structure with a long shape that weighs 200 grams and measures 20cm in length and is made up of three parts: a head, a body and a tail. It is located in the upper part of the abdominal cavity, behind the stomach and intestines and is intimately related to the liver and the biliary tracts, as well as other organs not involved in digestion.

As a result of its location, the most common diseases of the pancreas are related to or affected by, in an indirect way, the pathology of nearby organs (such as gallbladder or biliary tract stones). In fact, one of the most important arguments for deciding when to carry out surgery to resolve the problems that gallbladder stones can cause is when they cause some type of damage to the pancreas, such as acute pancreatitis.

Dr. Fabio Ausania

“The symptoms of the pancreas and disease are invariably related to the function of its surrounding organs”

Dr. Fabio Ausania

For all these reasons pancreatic surgery is always complex and requires great experience from the surgical team, given its peculiar disposition in the depth of the abdomen and the close contact with vital structures for the organism.

Continue reading the following paragraphs and sections of this blog to understand what the diagnosis and treatment of pancreatic diseases consist of and how they can affect a proper diagnosis and nutritional and metabolic balance.


The two main functions of the pancreas are: exocrine function, for digestion, and endocrine function, charged with the production of hormones for the regulation of metabolism.

Anatomía y función del páncreas

1. Exocrine function of the pancreas

The pancreas carries out a fundamental function in the digestion process, given that it has several glands that produce important enzymes for the process that absorb the different elements that make up our food.

Pancreatic enzymes include: trypsin to digest proteins (meat, fish, eggs etc…); amylase to digest carbohydrates (sugar, bread, pasta, rice etc…); and lipase to decompose fat (oil, lactose, meat etc…). The function of these is to chemically decompose the fat and proteins ingested in smaller portions that can be absorbed by the intestine. When food reaches the stomach, these pancreatic juices are released in a conduction system of various diameters that culminate in the main pancreatic channel. The pancreatic channel joins with the common biliary channel to make up the ampulla of Vater, which is found in the first part of the small intestine, called duodenum. The common biliary channel originates in the liver and transports another important digestive liquid, called bile. The gallbladder is the bile reservoir that acts as storage when we are on an empty stomach.

The pancreas carries out a fundamental function in the digestion process, given that it has several glands that produce important enzymes for the process that absorb the different elements that make up our food

The pancreatic juices and bile that are released in the duodenum help the body to digest and absorb nutrients from the food so that they pass to the blood to be used for all the cells of the organism.

Therefore, one of the first consequences of the process that affects the proper excretion of these enzymes, such as specific pancreatic lesions (cysts, tumours of the pancreas or other benign entities) or inflammatory processes (pancreatitis), is a sensation of difficulty in digestion, pain in the upper part of the abdomen, loss of weight  and a tendency to diarrhoea.

Dr. Fabio Ausania

“One of the first consequences of the process that affects the proper excretion of these enzymes, such as specific pancreatic lesions (cysts, tumours of the pancreas or other benign entities) or inflammatory processes (pancreatitis), is a sensation of difficulty in digestion, pain in the upper part of the abdomen, loss of weight  and a tendency to diarrhoea”

Dr. Fabio Ausania

2. Endocrine function of the pancreas or the production of hormones

The endocrine component of the pancreas is made up of highly specialised cells that create and release important hormones for metabolism directly into the bloodstream. These cells are grouped together in functional groups of a few millimetres of calibre called islets (islets of Langerhans). The islets are found distributed throughout all the pancreas, although mainly in large numbers in the body and above all in the tail.

Two of the main pancreatic hormones are insulin, that acts to reduce sugar in the blood after meals, and glycogen, that acts to increase sugar in the blood if need be (when the stomach is empty). There are also other hormones produced in the islets of Langerhans that regulate other digestive functions; from bowel movements to absorption, transport and use of nutrients for the cells of the body. In synthesis, the pancreatic hormones make all the other implicated organs in digestion interact so that the organism can transform food into energy.

The pancreatic hormones make all the other implicated organs in digestion interact so that the organism can transform food into energy

This regulation is fundamental for maintaining adequate and constant levels of sugar (glucose) in the blood, so that this continuously reaches key organs such as the brain, lungs, liver and kidneys. They use glucose to maintain their function both when we have just eaten and when we have to stop eating for shorter or longer periods.


There is a wide variety of pancreatic diseases, but the most frequent and serious are caused by inflammatory processes (acute or chronic pancreatitis) or by the appearance of tumours (pancreatic cancer).

Consult our experts for any type of doubt or in case you have or need a diagnosis for a pancreatic pathology


Acute pancreatitis

An important group of pancreatic diseases is the presence of inflammatory or processes or pancreatitis. When the inflammatory reaction is produced as a consequence of a one-time trigger factor, acute pancreatitis is produced. In our environment, the majority of cases are produced by passing of a gallstone (acute biliary pancreatitis) from the vesicle to the mouth of the ampulla of Vater where there is an obstruction in the passing of pancreatic juice to the intestine. The pancreatic gland can produce almost a litre of digestive secretions every day, and an obstruction at any level of the ducts can cause a huge inflammation with serious symptoms, among them the most frequent is pain in the upper abdomen which radiates to both sides and the back (pain in the waist).


Pancreatitis aguda - Pancreatitis biliar

In 80% of cases, acute pancreatitis is light and remits spontaneously, without an affect on the pancreatic function. However, 20% of cases are serious and require intensive treatment and on occasions surgical intervention with external drainage of secretions for their recovery. The treatment of biliary disease with serious symptoms such as intense abdominal pain after meals, pancreatitis, inflammation of the gallbladder (colecistitis), obstruction or infection of the biliary channels (colangitis) are treated with the elimination of the cause, meaning the surgical removal of the gallbladder.

There are other causes of acute pancreatitis (alterations of the immune system, genetic hereditary diseases, metabolic alterations, some medicine, cystic lesions of the pancreas, IPMT, etc…) among them the one that stands out is acute pancreatitis due to alcohol abuse (acute alcoholic pancreatitis, that can degenerate into chronic pancreatitis in case of high levels of frequent alcohol consumption). When a patient presents acute pancreatitis that repeats, even if on a low level, and there are no gallbladder stones in the classical diagnostic tests (ecography) nor a high level of alcohol consumption, you should always get a second opinion in a centre specialised in the treatment of pancreatic diseases to rule out rarer causes potentially susceptible to a specific treatment, both medical as well as surgical.

Chronic pancreatitis

If the inflammatory process produces after a long exposure time to a hazardous factor, chronic pancreatitis can be produced. In our environment, this pancreatic disease is usually caused by an elevated and constant ingestion of alcohol over several years. This case is characterised by the progressive and irreversible destruction of the glandular tissue and pancreatic functions. The loss of function comes with, in advanced cases, huge weight loss (for the inability to absorb nutrients from food) and diabetes (the lack of insulin causes high glucose levels in the blood, that can be hazardous to organs such as the kidneys, heart and eyes among others). The normal pancreas is substituted for hard scar tissue and the ducts can be filled with stones. These alterations cause other symptoms that patients with this disease usually present, such as difficult to treat abdominal pain even with pain medication; the obstruction of biliary tracts that cause jaundice, meaning a yellowing of the skin and the eyes, accompanied by dark urine; and even difficulty passing food from the stomach to the intestine due to narrowing of the duodenum as a consequence of the increase in pancreas rigidity. All of this causes a huge loss of weight and difficulty in nourishment that can be very debilitating. In very selective cases several surgical interventions might be necessary according to pancreatic symptoms.

Pancreatitis crónica

In the case that similar symptoms are presented, and they can be related to pancreatic function, consult our experts. You should consider a second opinion from a surgeon specialised in the pancreas, with experience in the treatment of lesions of chronic pancreatitis. This type of pancreatic surgery can relieve the described digestive symptoms and, above all, control abdominal pain, which in intense cases can’t be controlled by conventional medicine.

Pancreatic cancer

The most frequent pancreatic tumours are precisely from the types of cells responsible for the digestive function of the pancreas. The malignant tumour derived from these cells is pancreatic adenocarcinoma, also known as pancreatic cancer. It’s an extremely aggressive disease, of rapid growth and with a great tendency to affect nearby and faraway organs. That’s why the diagnosis of pancreatic cancer is frequently carried out in advanced stages of evolution, when there is little chance of recovery.

The surgical resection of pancreatic tumours, apart from being the only possibility of curative treatment, represents a surgical act with high risk of complications (over 50%) and mortality (up to 5%) in centres specialised in this type of intervention. These complications are also due to patients previously to the intervention being in bad general shape for various reasons: huge loss of weight, problems with secondary digestion to pancreatic deficiency, obstruction of the biliary tract when located in the head (jaundice), diabetes mellitus… Or other mechanical problems related to the location of the tumour, for example, difficulty in nourishment due to obstruction of the duodenum. When the tumour is located in the body or in the tail of the pancreas, the first symptom can be intense pain which is difficult to control with pain medication.

Cáncer de páncreas

Pancreatic cancer is the fourth cause of death in Spain, with approximately 4,000 diagnosed cases every year. The number of cases of this tumour increased constantly by 1.2% per year between 2000 and 2012: it is expected that pancreatic cancer can represent the second cause of death by cancer in 2030 (today it’s the sixth). Pancreatic surgery, and in particular the resection of the head of the pancreas is a very complex surgery with a high surgical risk associated with a high rate of serious posterior complications. The probability of suffering a complication increases proportionally with age and the pre-operative diseases of each patient.

As we have previously mentioned, pancreatic function is fundamental in nutritional and digestive terms: the endocrine pancreas regulates the energetic metabolism via insulin production, glucagon and other hormones. The exocrine pancreas for its part mainly produces the necessary enzymes for the digestion and absorption of food. In the cases of pancreatic cancer or other lesions of the head of this organ, both the endocrine and the exocrine functions are affected. The exocrine pancreatic insufficiency presents itself as weight loss and diarrhoea, while the endochronic insufficiency can cause diabetes mellitus. Although endocrine and exocrine neoplasia of the pancreas can appear, the prevalence of exocrine pancreatic cancer (95%) is much higher than endocrine pancreatic tumour (5%).

Dr. Fabio Ausania

“Endocrine and exocrine pancreatic cancer can appear, however the prevalence of exocrine pancreatic cancer (95%) is much higher than endocrine pancreatic tumour (5%)”

Dr. Fabio Ausania

Malnutrition, a disease in which the caloric ingestion of the patient doesn’t meet metabolic demands, is very common in patients who have pancreatic cancer. More than 80% of patients with pancreatic cancer show weight loss on being diagnosed and more than a third of those patients have lost more than 10% of their initial body weight. Patients with pancreatic cancer with malnutrition experience a lower quality of life, more surgical complications and death, longer hospital stays and a reduced response to postoperative chemotherapy treatment.

Patients with pancreatic cancer with malnutrition experience a lower quality of life, more surgical complications and death, longer hospital stays and a reduced response to postoperative chemotherapy treatment

An association between pancreatic cancer and diabetes has been established by a great number of studies. In fact, epidemiological, clinical and experimental tests support the concept that diabetes is induced by pancreatic cancer and can precede the appearance of specific symptoms of cancer for various months. Patients with recently diagnosed diabetes have a risk between 5 and 8 times higher of having a pancreatic cancer diagnosis in the first three years following the development of diabetes.

The biggest chance of successful treatment of pancreatic cancer is found via early diagnosis, a suitable surgical intervention in an early stage with a low rate of complications and an effective oncological treatment (chemotherapy and or radiotherapy). It is important to differentiate between pancreatic tumour and biliary tract cancer (cholangiocarcinoma) given that this presents a better prognosis in the long term with respect to pancreatic cancer, if it’s diagnosed in the early stages.

For these reasons it’s fundamental to undergo pancreatic surgery by an expert surgeon at a centre of recognised experience in the treatment of this pathology. A patient should ask for a second opinion from an expert centre when the diagnosis is pancreatic cancer. Not only with the end of undergoing surgery with the lowest possible rate of complications, but also for evaluating the best treatment strategy and the possibility of carrying out chemotherapy before surgery. A second opinion also is important when a certain type of treatment has been ruled out (surgical, oncological or symptom control) in other centres and alternative therapies can be proposed to improve the quality of life of these patients.

Neuroendocrine tumour of the pancreas

A tumour derived from the cells responsible for the endocrine function of the pancreas is known as neuroendocrine tumour of the pancreas. This type of tumour is very distinct to the previous one and, in general, has a better long term prognosis, given that it has a lower tendency to attack other organs it grows slower. One characteristic of neuroendocrine tumours of the pancreas is that a part of them has the capacity to produce hormones, according to the islet cells of their origin. This overproduction leads to the appearance of a combination of symptoms that vary in function of the hormone produced. In general, the indication of neuroendocrine tumours of the pancreas treatment comes determined for its symptomatology and its size, as well as its genetic characteristics of the cells that are obtained after an endoscopic puncture for diagnostic purposes (biopsy).

In order to differentiate between the distinct types of pancreatic lesions it’s important to extract a tissue sample (biopsy) which is obtained via a digestive endoscope with a fine needle puncture in order to analyse the material through different cellular studies. Via the endoscope. You can carry out a direct ecograph of the pancreas via a duodenum (echoendoscope) for the purposes of characterising the lesion, knowing if it’s solid or liquid, the relationship with the organs that surround the pancreas, etc.

There are small neuroendocrine tumours of the pancreas, generally just a few millimetres in size. This type of neoplastic is sometimes diagnosed incidentally (they don’t cause any symptoms) during the study via image (CAT, MRI) of other abdominal pathologies. These lesions, in the same way as for pancreatic cancer, are evaluated by pancreatic surgery after an exhaustive multidisciplinary study carried out by radiologists, gastroenterologists, endoscopists and pathologists. This team decides whether to carry out a follow-up in time with radiological tests in order to control the eventual growth or pancreatic removal surgery, with distinct techniques according to the location or the type of tumour. A second opinion from an expert surgeon in these pathologies should always be requested if the patient is diagnosed with a neuroendocrine tumour. If it’s to plan a surgery with minimal complications or to decide a simple follow-up in the low-risk lesions and save the patient from a complex surgery that might be unnecessary.

Intraductal Papillary Mucinous Tumour – IPMT

Apart from malignant tumours, there are pathologies that are, in principle, benign whose early removal can avoid the development of pancreatic cancer. The most frequent benign pancreatic tumour is the Intraductal Papillary Mucinous Tumour (IPMT). These lesions require a complete diagnosis, which on occasions can require various complementary tests and in some cases surgical intervention. IPMT is a rare pathology, but whose diagnosis is more frequent in its early stages in the form of a cyst (bag of liquid content inside the pancreas) of distinct sizes, throughout the whole gland. This type of tumour is usually diagnosed casually in image tests made to study other diseases, given that in the majority of cases it doesn’t cause any symptoms. When the Intraductal Papillary Mucinous Tumour causes symptoms, the most frequent is acute pancreatitis. Acute pancreatitis is a way of degenerating pancreatic ducts that produce mucus, which impedes the adequate secretion of distinct juices, that are usually much more fluid. There are two types of IPMT, one of them is manifested with a dilatation of the main pancreatic duct and the other in which dilatation of the secondary duct is presented. These two ways can coexist in the same patient, and the risk assessment of degeneration is made via the analysis of the radiological image and endoscopic tests carried out by doctors who are experts in this pathology. Each way has its particular risk and a regular check-up of the evaluation will be necessary with image tests or pancreatic surgery in the most serious cases. The decision will be made according to the risk assessment that will be done by radiologists, gastroenterologists and pancreatic surgeons.

Tumor Papilar Intraductal Mucinoso - TPMI (o IPMN)

You should request a second opinion from a centre used to treating a high volume of patients with this pathology as long as there is a suspicion or a confirmed diagnosis of IPMT. The importance of consulting a surgeon with experience with this disease consists of the capability to interpret distinct tests to evaluate the risk of degeneration and be able to indicate the most surgery. The second opinion of an expert is also important to differentiate Intraductal Papillary Mucinous Tumour from other types of benign cysts of the pancreas, that sometimes have similar characteristics and don’t need any type of treatment or evolutionary control.



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