Breaking Down Myths: Can You Live Without a Pancreas?

Nestled within the abdomen, between the spine and the stomach, the pancreas plays a crucial role in digestion and blood sugar regulation, ensuring the body receives vital nutrients while maintaining glucose levels. However, circumstances may necessitate the removal of this crucial organ through a surgical procedure known as pancreatectomy. Despite the challenges posed by pancreas removal, individuals can navigate this new reality through medical interventions and lifestyle adjustments, fostering a path toward successful adaptation and well-being.

What is the pancreas?

The pancreas is one of the main organs involved in the digestive system. It is a gland, which means it produces and secretes substances such as hormones and digestive juices. Its close proximity to the small intestine, liver, and gallbladder allows it to work together with these other organs to help you extract nutrients from food.

The role of the pancreas

The pancreas has two primary functions: to regulate blood sugar levels and to help you digest food. Both functions are necessary for human survival. It satisfies these functions through its role as both an endocrine gland and an exocrine gland.

Endocrine functions of the pancreas

Endocrine glands release substances directly into the bloodstream. The major hormones released in this way by the pancreas include insulin, produced by beta cells, and glucagon, produced by alpha cells.

The pancreas plays a crucial role in regulating blood sugar levels. When we eat, it releases insulin, which helps cells utilize glucose for energy, lowering blood sugar levels. Conversely, glucagon prompts the release of glucose from carbohydrate stores in the body, leading to an increase in blood sugar levels.

Together, insulin and glucagon keep your blood sugar levels within a healthy range.

Exocrine functions of the pancreas

Exocrine glands release substances through a duct. The pancreas produces digestive enzymes and releases them into the first part of the small intestine called the duodenum, where they help you break down food. The enzymes trypsin and chymotrypsin digest proteins, amylase digests carbohydrates, and lipase digests fats.

When broken down into smaller molecules, these macronutrients can be absorbed into the bloodstream and utilized for energy and other purposes by cells throughout the body.

Can you live without a pancreas?

Living without a pancreas is possible as long as you receive lifelong medical treatment. Since the pancreas produces insulin and digestive enzymes, you will need to take external sources of these substances to survive. Having no pancreas means you will have diabetes, so adhering to a diabetes diet is also important.

One study showed that patients receiving a total pancreatectomy — surgery in which the entire pancreas is removed — can survive for years after their procedure. Up to 76% of patients who underwent a total pancreatectomy for reasons unrelated to cancer survived for at least 7 years, while 31% of patients who underwent the surgery for cancer were still alive after 7 years.

Why would the pancreas be removed?

A total pancreatectomy is necessary when other types of treatment — including partial removal of the pancreas (partial pancreatectomy) — would unsuccessfully treat the underlying disease or its complications.

1. Chronic pancreatitis

Chronic pancreatitis refers to progressive, long-term inflammation of the pancreas that leads to the destruction of the glands responsible for producing hormones and digestive enzymes. Chronic pancreatitis affects up to 12 per 100,000 people, most often males between ages 35–54. People with chronic pancreatitis are 10–20 times more likely to develop pancreatic cancer compared to the general population.

Symptoms of chronic pancreatitis include abdominal pain which can be severe and persistent, excessive gas and bloating, nausea and vomiting, diarrhea or oily stools, and unintentional weight loss.

Some causes of chronic pancreatitis include:

• Hereditary pancreatitis. This is an inherited condition in which a gene mutation causes enzymes to damage the pancreas. It typically starts in late childhood with an acute episode of pancreatitis. Recurrent bouts of pancreatitis lead to chronic inflammation usually by early adulthood.
• Heavy alcohol consumption. This is the most common cause of chronic pancreatitis, accounting for up to 70% of cases. While there is no clear threshold, most people who develop alcohol-related chronic pancreatitis consume at least 5 drinks daily for at least 5 years.
• Smoking. Smoking accounts for about 25% of the attributable risk of chronic pancreatitis. When combined with heavy alcohol consumption, the risk of smoking-related chronic pancreatitis is significantly increased.
• Hypertriglyceridemia. Severely high levels of triglycerides, usually due to a hereditary condition, increase the risk of chronic pancreatitis.

Many other causes of chronic pancreatitis exist, including autoimmune diseases, high calcium levels, or chronic obstruction of the pancreatic duct by tumors, gallstones, or cysts.

Total pancreatectomy is often performed for people with chronic pancreatitis to alleviate unremitting pain and prevent progression to pancreatic cancer.

2. Pancreatic cancer

Pancreatic cancer carries a grim prognosis, as the disease is often detected in the later stages when the cancer has already spread. Pancreatic cancer can cause abdominal pain, jaundice, itching, dark urine, loss of appetite, and unintentional weight loss.

Research shows that a total pancreatectomy for pancreatic cancer may not offer additional survival benefits compared to a partial pancreatectomy when there is a reasonable choice between the two.

However, a total pancreatectomy may be necessary in certain cases, such as when:

• A partial pancreatectomy would not leave behind sufficient functional tissue.
• The cancer is too large or extensive to be removed by partial pancreatectomy.
• Life-threatening infection or bleeding occurs as a complication of partial pancreatectomy.
• Another cancer (such as renal cell cancer) spreads to the pancreas.
• The cancer co-exists with extensive precancerous lesions.

3. Trauma to the pancreas

Traumatic injuries to the pancreas — such as from blunt trauma (e.g., car accident) or penetrating trauma (e.g., knife wound) — are associated with a mortality rate of up to 25%. Additionally, surgery to fix traumatic injuries to the pancreas carries a high rate of complications ranging from 26 to 86%.

Pancreatic trauma is quantified by severity on a scale ranging from grade I to grade V. Usually, treatment involves non-surgical measures or local techniques such as drainage, suture repair, and partial pancreatectomy. The higher the grade, the more likely you’ll need surgery.

However, a total pancreatectomy is rarely performed in pancreatic trauma cases. Only when there is massive injury or bleeding that cannot be controlled with less intensive measures do surgeons consider a total pancreatectomy.

Recovery after removal of the pancreas

Nutritional optimization is essential after a total pancreatectomy. Without a pancreas, blood sugar levels can increase dramatically in a short period of time. While recovering in the hospital, which can take days to weeks, patients typically receive insulin to keep their blood glucose levels stable. Insulin is continued after discharge and throughout the remainder of the patient’s lifetime.

A person’s appetite can be reduced following the removal of the pancreas. This is partly due to delayed emptying of the stomach, which occurs normally after surgery. As soon as the first postoperative day, patients can be started on a clear liquid diet as long as they are able to tolerate it.

Diet is then advanced slowly based on patient tolerability, with the addition of supplemental digestive enzymes when the patient is able to eat solid foods. In certain cases, a nasogastric tube may be necessary for patients who are unable to eat.

Other short-term post-operative measures include:

• Draining fluids from the abdomen through the use of drainage tubes
• Preventing blood clots through heparin injections or sequential compression stockings
• Increasing physical activity levels gradually
• Receiving vaccinations if the spleen is also removed as a part of the surgery

Life changes after pancreas removal

Living without a pancreas requires strict adherence to insulin treatment, a diabetes (low-sugar, low-carbohydrate) diet, and supplemental digestive enzymes.

After a total pancreatectomy, patients may struggle to manage a new health condition: diabetes. They must begin to take insulin regularly, and regimens are highly customized based on the patient's needs. After pancreas removal, patients must be diligent about measuring their blood sugar levels before and after meals for some time as they settle into the right insulin regimen. Usually, patients will take a standard long-acting insulin as well as meal-time insulin to keep their blood sugar levels in check.

A second major component of living without a pancreas is pancreatic enzyme replacement therapy (PERT). Without an external source of digestive enzymes, patients can experience symptoms of indigestion as well as long-term vitamin and nutrient deficiencies.

Some experts recommend a starting dosage of 30,000–40,000 international units (IU) of pancreatic enzymes with each meal — taken half at the beginning and half at the end — and 15,000–20,000 IU with snacks. Doses may be adjusted based on the patient’s symptoms and response. Common PERT formulations include Creon, Pancreaze, Pertyze, and Zenpep.

Final words

It is certainly possible to live without a pancreas. While a last resort, total removal of the pancreas is often necessary for people with conditions like chronic pancreatitis or pancreatic cancer. If you suffer from a pancreatic condition, consult with your physician to determine whether a total pancreatectomy is necessary or whether less intensive options can achieve the outcomes you are hoping for. Even if you do undergo total pancreas removal, navigating the daily challenges of life is doable with the right nutritional support and medical treatment.