Located deep in the abdomen, the pancreas is a vital part of the digestive system and a critical controller of blood sugar levels, releasing the hormones insulin and glucagon into the bloodstream to help control how the body uses food for energy.
Given the importance of the pancreas as an organ, you might think living without one is impossible – like trying to live without a heart. But you can in fact live without a pancreas. Thanks to advancements in Medicine and the technology with which to administer it, we can now more effectively than ever reproduce what the pancreas does when it becomes necessary to remove all or part of the organ because of pancreatic cancer or other pancreatic diseases.
Partial pancreatectomy, or only removing part of the pancreas, is much more common than a total pancreatectomy, or removing the entire pancreas. Total pancreatectomy is most commonly performed for patients who have a so called “field-defect” that places their entire gland at risk for developing cancer. This occurs rarely, but some genetic conditions or pre-cancerous lesions can require such an operation.
Thus it is important for at-risk patients to know their options and ask their physician if they qualify for either a partial or total pancreatectomy.
So how do you live without a pancreas or only a partial one? The short answer is medications, lifestyle changes, and in rare cases, transplantation of the hormone-producing pancreatic cells.
Supplementing pancreatic function
In addition to regulating blood sugar levels, the pancreas secretes powerful enzymes into the intestines to help break down fatty foods so our bodies can use the nutrients. For the most part, we can supplement both these functions with medication. We replace pancreatic enzymes with pills taken before meals to help with the absorption of food.
To manage blood sugar levels, we use long-acting insulin and rapid-acting insulin, which, together, mimic the regular function of the pancreas, doling out small amounts of insulin throughout the day and larger amounts after a meal. To maintain this normal pattern, patients will take from one to four shots of insulin a day.
For partial pancreatectomies, the amount of supplemental treatment a patient will need depends entirely on the health of the remaining pancreas. Patients who have normal function going into surgery can lose up to two-thirds of the pancreas and not require supplemental insulin if their remaining gland is relatively normal.
Lifestyle changes
The patient’s willingness to engage in the necessary lifestyle changes is key to a healthy recovery and healthy life after a partial or complete removal of a pancreas.
After this surgery, patients must be deliberate about checking blood sugar levels, planning what and how much they eat, and paying attention to their bodies. It can sound daunting, but patients learn to work around these challenges.
While discipline and regular attention are important, the treatments are not completely unforgiving if a patient misses one or two pills or injections. If skipped regularly, however, patients will likely begin to experience the side effects of uncontrolled diabetes.
For example, neglecting insulin injections can lead to damage causing blindness, stroke, heart attack, kidney failure, and nerve damage. Forgetting enzyme pills can contribute to vitamin deficiencies that result in profound osteoporosis or gastrointestinal issues such as diarrhea and fatty stools.
The biggest challenge with the enzyme pills is the cost. For patients without prescription drug coverage, it can be very difficult to afford those pancreatic enzymes. Insulin is comparatively affordable; the enzymes are costly.
Another option to maintain insulin levels are insulin pumps where a small tube is inserted under the skin to provide a constant infusion of short-acting insulin throughout the day. This device can be programmed with body-specific needs and will release larger amounts of insulin in response to a meal. It only manages insulin and cannot predict when the sugars will start to dip.
Why remove a pancreas in the first place?
There are several reasons we would consider removing a patient’s pancreas, including hereditary pancreatitis, chronic pancreatitis, intraductal papillary mucinous neoplasm (IPMN), and cancer.
Pancreatitis is a condition in which the pancreas becomes inflamed. The hereditary form, caused by genetic mutations, predisposes some patients to recurrent pancreatitis. These patients have up to a 40 percent risk of developing pancreatic cancer over their lifetime. For these individuals, we would consider removing the entire pancreas because the entire organ is at risk for cancer.
Chronic pancreatitis is long-lasting, and often the pain is severe. Patients who come to us with lifestyle-limiting pain from this disease may be candidates for having part or all of their pancreas removed.
IPMN is a precancerous condition. If lesions are progressing throughout the main pancreas duct, we will remove the entire pancreas to prevent IPMN from turning into pancreatic cancer.
As for cancer, surgery is an option only 20-40 percent of the time, and often the treatment involves removing only part of the pancreas. We remove the entire pancreas if a patient has more than one tumor or if he or she has an underlying disease in the pancreas as a whole even if cancer is in only part of the organ. That’s because there is a very high risk the patient will develop another cancer elsewhere in the pancreas.
Considering pancreas transplants
While pancreas transplants are possible, this procedure is not typically used for post-pancreatectomy patients. These transplants are typically considered for patients who have Type 1 diabetes and who have significant resulting conditions, including blindness and kidney failure. With new technologies, however, pancreas transplants may become a thing of the past.
A related process that may stand the test of time is islet autotransplantation. In this procedure, a physician removes the pancreas and auto digests it, isolating the islet cells that produce insulin and then fusing those cells back into the patient’s liver. The hope is these cells will engraft and grow in the liver, retaining some of the pancreas’ function.
In the United States, if a patient has cancer – or is at risk for cancer for any reason – it is considered unethical to fuse these islet cells with the liver because they have the potential to be cancerous. There are programs in France and Spain doing this with success, even in cancer patients, but in the U.S. we reserve this surgery only for patients with inflammatory conditions.
Emerging technologies
Insulin production is critical, but there are additional concerns with a total pancreatectomy. We worry more about the loss of glucagon, a counter-regulatory hormone that prevents the amount of glucose in the blood from dropping to a dangerously low level.
A promising emerging technology is the artificial pancreas. This device incorporates insulin pump technology with a continuous glucose monitor capable of interpreting blood sugar levels. Based on this information, it can then increase, decrease, or hold its secretion of insulin or glucagon accordingly. The artificial pancreas is currently in clinical trials at sites across the United States.
Life after pancreatic surgery
We find that our adult patients adapt remarkably well to the lifestyle changes necessitated by a pancreatectomy and, in effect, living without a pancreas. Patients are willing to adapt because the procedure is either addressing unrelenting pain from problems like pancreatitis or treating and preventing cancer. For those with diabetes or pancreatitis, the daily routine might not be a drastic departure because they’ve probably taken enzymes or used insulin already.
For others, though, preparing for lifestyle changes prior to the procedure is key. Before a total pancreatectomy, we always discuss with patients what life will be like without a pancreas so they can plan and understand the expectations and demands and make an informed decision.
Living without a pancreas is indeed possible, and to a degree that you’re not just surviving, but thriving.
