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Distal pancreatectomy is an operation to remove a tumor from the body or tail of the pancreas. It is performed to treat pancreatic cancer and other disorders of the pancreas. Given the pancreatic pathology, your surgery may involve removal of the spleen as well.  

Risks and possible complications of the operation:

• Bleeding
• Infection, at the level of the wound, or intra-abdominal, or bloodstream
• Pain

Risks of anesthesia

• Delayed emptying of stomach, which results in nausea, vomiting, delaying oral intake, and may require prolonged use of a nasogastric tube
• Leakage from the pancreas (pancreatic fistula)
• Diabetes
• Exocrine insufficiency due to loss of pancreatic enzymes (inability to absorb fat and nutrients causing diarrhea; may require you to take pancreatic enzymes with your meals)
• Injury to nearby organs: colon, small bowel, stomach
• Blood clot forming in your legs and lungs
• Heart attack
• Death

How to prepare prior for surgery

• Discuss with your surgeon your use of blood thinning medications such as Warfarin, Lovenox, Heparin, Pradaxa, Xarelto, Eliquis, ASA, Plavix, and other anticoagulants/antiplatelets.
• Exercise daily prior to surgery. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.
• Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
• If you are a smoker, stopping smoking four weeks before surgery is strongly recommended to lower the risk for lung and wound complications.  
• Shower with an antimicrobial soap the evening before and the morning of surgery. Please, do not shave the surgical area 48 hours prior to surgery.
• The day before your surgery, you may eat a regular diet. Starting midnight, you may only drink clear liquids (sports drinks, tea, coffee without creamer or milk, apple juice, water, clear broth, popsicles). You can continue with a clear liquid diet until two hours prior to your surgery.
• In the event that your spleen will be removed, you will receive vaccines two weeks prior to scheduled operation. After spleen removal, you are more likely to contract serious or life threatening infections, thus compliance with vaccination is imperative. These are vaccines against pneumonia, influenza, Haemophilus influenzae type b(Hib) and meningococci. Some of these vaccines will need to be repeated in five years. A vaccine schedule will be provided to you for your records.
• 1-7 days prior to your scheduled surgery, pre-anesthesia clinic will call you to review your medical history and medications as well as review pre-operative instructions.  Pre-anesthesia clinic number: 520-694-4232.
• A surgery scheduler will call to confirm your surgery and arrival times by calling your phone number on file between  2 p.m. and 4 p.m. the day prior to surgery. (For Monday surgeries, you will receive a call on Friday).  Please, make sure to answer the call and check your voicemail. Scheduler number: 520-694-2873.

What to expect the day of surgery

• The morning of surgery, you will check in at the admission desk on the first floor and register. They will send you up to the preoperative waiting room on the third floor once you are registered.
• Nurses and staff members will confirm your name, date of birth, procedure, and surgeon. This will be done multiple times by multiple people during your stay to ensure your safety.
• You will need to change into a surgical gown.
• Before surgery, an IV line is put into a vein usually in your arm. This is used to inject fluids and medications into your veins as needed.
• While you are asleep, additional IV lines may be placed.
• While you are asleep, we will insert a urinary catheter into your bladder, and a nasogastric tube which will extend from your nose into your stomach. Both of these tubes will be present when you awake.
• Upon completion of the operation, your surgeon will place one drain into the abdominal cavity which will extend out through the skin and remain in place for the next few days. There are times when you will need to go home with the drain in place. If this is the case, you will be shown how to care for it.  
• The anesthesia team will block the nerves around your incision before you wake up to help with pain control after surgery.

What to expect after surgery

After surgery, you will be admitted to the hepatobiliary floor for recovery (9EW). The following outlines the expected daily progress; however, each patient is unique and daily progress may vary.

Day 0:  

• You will receive pain medications and IV fluids, and lab work will be monitored daily.  
• At all times while in bed, Sequential Compression Devices (SCDs) will be wrapped around your legs and inflated with air. This helps prevent blood clots.
• You will also get blood thinner shots to help prevent blood clots. If you have cancer, you will go home with these shots for a total of 28 days from time of surgery  
• You may have a tube in your nose (nasogastric tube), this tube is connect to wall suction. It helps suction fluid from your stomach and prevent nausea.  
• You may have a urinary catheter which will drain urine from your bladder.  
• Your goal is to sit on the side of your bed or up in a chair at least one time on the day of your surgery.  
• You will be given a breathing machine (Incentive Spirometer); you should use this 10 times every hour while you are awake. It is important to exercise your lungs so they expand fully, which can help prevent pneumonia. You can take this machine home with you.  
• We will check your blood sugar every 6 hours.  

Day 1:  

• Nasogastric tube is removed; this can vary depending on your individual situation. It may stay in a day or two longer but is usually removed by 24-48 hours after surgery.  
• Urinary catheter is removed.  
• Your diet will be advanced to clear liquids if you are not nauseated or vomiting.
• You will be asked to be out of bed in a chair most of the day and walk at least 4 times daily until discharge. Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements again. Your nurse or physical therapist will help you move around, if needed. 

Day 2:

• If you don’t have nausea or vomiting, your diet will be advanced each day at your surgeon’s discretion.
• Ambulation, Incentive Spirometer, eating only in an upright position will be encouraged daily.

Day 3-5:  

• Abdominal drains may be removed or decision may be made to keep the drains for a longer period of time.  
• Discharge planning home or to a skilled rehabilitation facility per patient need.
• If your spleen is removed, you will be scheduled for post splenecomy vaccination.  Make sure you have a full understanding of your post spleenectomy vaccination schedule. 

What to expect while at home

• While recovering at home, ambulation is encouraged with progressive return to pre-operative physical state.  
• Don’t lift anything heavier than 10 lbs. for at least 2 weeks after surgery, then nothing more than 25 lbs. for 6 weeks from the date of surgery. Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better.
• You will be discharged home on the following new medications:
  • Lovenox for VT prophylaxis X 28 days after surgery (if operation performed for a malignant disease).  This helps lower the occurrence of blood clots in the legs and lungs
  • Pain medication
  • Senna S and Miralax while taking pain medication to avoid constipation.
• A specialized diet after this procedure is often unnecessary and the diet should only be tailored for symptom management (small and frequent meals ( 6-7meals/day) if you are experiencing early satiety, nausea, decrease in appetite)
• You will need to maintain a daily log of your glucose levels at home which you will bring with you on your first follow up with your surgeon.  Minimum of 6 blood glucose testing occasions per day should be documented: prior to all meals and snacks, before bed, in the presence of suspected hypoglycemia symptoms (shaky, sweaty,nervous, low in energy, lightheaded), and before critical tasks (driving, swimming, using dangerous equipments).
• You will resume all your home medications unless you are told to stop one of them.
• You may be discharged home with abdominal drain(s), and if so, you will receive instructions on how to care for your drain(s) and how to monitor how much fluid is draining from the tube(s).
• It is normal for the skin below your incision to feel numb. This happens because some of the skin nerves were cut during your surgery. The numbness will go away over time.  
• If you have staples in your incision, they will be removed during your first appointment after surgery.  Keep your wound clean with daily showers.  
• If you have steri-strips and no staples, let the steri-strips fall off on their own, which will take approximately 2 weeks.
• Do not drive if you are taking pain medications that may make you drowsy.
• Your have any questions or concerns after you leave the hospital, call the surgical clinic for assistance: The University of Arizona Cancer Center, 3838 N Campbell Ave, Tucson, AZ 85719, ph:520-694-2873.
• For emergencies or with any questions/concerns after 5 p.m. on weekdays and anytime on weekends, call 520-694-XXXX.  Provide your surgeon’s name and ask for the HPB resident on call.