The pancreas, a yellowish gland behind the stomach,about 2–3 cm thick ,15 cm long, 5 cm wide, and serves two primary functions: 1) aiding digestion (exocrine function) and 2) regulating blood sugar (endocrine function).

For digestion, the pancreas generates enzymes (amylase, lipase, and protease) that break down ingested nutrients like carbohydrates, fats, and proteins. It also produces bicarbonate to counteract stomach acidity, crucial for effective digestion. To prevent self-digestion, the secretion contains inactive precursors that activate in the small intestine.

Within the pancreas are clusters of cells known as islets of Langerhans, producing hormones like insulin and glucagon. These hormones, essential for carbohydrate metabolism, travel through the bloodstream to organs like the liver and brain, providing energy for cells. Additional hormones, such as somatostatin and pancreatic polypeptide, are also produced, playing roles in overall metabolism.

Common symptoms of pancreatic diseases include pain or discomfort in the upper abdomen, often radiating to the back, along with jaundice, diarrhea, bloating, flatulence, or diabetes, and in some cases, additional signs like weight loss, skin lesions, and fatigue may occur due to the immune system's response to cancerous tumors.

Pancreatic cancer is a severe disease that requires prompt treatment; early detection through consultations, physical exams, and various diagnostic methods like laboratory tests, ultrasound, CT scans, MRI, and endoscopic examination is crucial, with further steps like diagnostic laparoscopy or trial surgery if needed for a clear diagnosis.

Surgery is the primary cure for carcinoma, addressing symptoms and consequences alongside pain management, digestion improvement, and insulin therapy. While chemotherapy and radiation treatments don't cure the disease, they enhance life quality. Modern multimodal therapy, including personalized chemotherapy and curative surgery, has enhanced prognosis and life expectancy for pancreatic cancer patients, improving their quality of life, mobility, and autonomy.

Pancreatitis is inflammation of the pancreas, either as an acute condition often caused by gallstones or excessive alcohol consumption, requiring hospital treatment, or as a chronic condition that progresses over years and leads to severe pain. Chronic pancreatitis, often triggered by alcohol, can result in the loss of pancreatic function, deficiency of enzymes, vitamins, and insulin, and may lead to cancer. Surgery for chronic pancreatitis becomes necessary in cases of uncontrolled pain, blockage of essential ducts, or uncertainty about tumor development. Timely surgery, performed by an experienced pancreatic surgeon, can help preserve important pancreatic functions.

Pancreatic surgery is recommended for conditions like pancreatitis, suspicious precancerous changes, and cancer, primarily when a malignant or premalignant neoplasm is present. Surgery may be required in acute pancreatitis only with complications, while in chronic pancreatitis, it's typically needed later in the disease progression (after 3 to 5 years).

Various options, including open and minimally invasive (laparoscopic or robot-assisted) procedures, are available. Minimally invasive approaches use small incisions and cameras instead of a large abdominal incision, with recent use of robot-assisted surgery. The choice depends on individual factors, disease type, progression, and the patient's medical and surgical history.

Potential risks of pancreatic surgery include internal infection or abscess, abnormal duct openings (fistula), bleeding, blood clots, lung infection, and heart problems. These risks can be managed through interventions like draining abscesses, using stents, blood transfusions, or medications. The likelihood of complications is lower in experienced surgical centers and higher in hospitals with less experience in pancreatic surgery.

Living without your pancreas is feasible, but it requires medication to replace digestive enzymes and insulin. Without insulin production, diabetes will develop, necessitating regular blood sugar monitoring and insulin administration. Ongoing interdisciplinary care involving surgeons, endocrinologists, gastroenterologists, and nutritionists is essential to manage blood sugar, diet, and overall health.

Patients who have had part or even all of their pancreas removed may experience functional impairment of the pancreas, depending on the extent of the removal. There are two main problems:

1.  too few pancreatic enzymes (leads to digestive problems)
2. too little insulin (leads to high blood sugar and diabetes)

These deficiencies can be substituted with appropriate medications.

A. Pancreatic Enzyme Substitution:

Use enzyme preparations (e.g., Kreon) to replace deficient pancreatic enzymes. Take these preparations with all meals and snacks, adjusting the dosage based on food type and symptoms.
Consume 5–6 meals a day, limiting fat intake or adjusting it to tolerance after major pancreatic surgery.

B. Insulin Substitution:

High blood sugar levels caused by pancreatic disease or surgery may require blood sugar therapy. Diabetes may develop with 60–90% pancreas removal or chronic inflammation damage. Control blood glucose levels through food adjustment and glucose-regulating tablets if levels are not highly elevated.
Insulin treatment may be necessary, closely supervised by a family doctor or specialist, especially in the initial phase.

Advanced pancreatic cancer can now be treated with improved chemotherapy and surgical techniques, providing curative options in specialized cancer centers. If curative surgery isn't feasible due to tumor progression or metastasis, multimodal therapies like chemotherapy, surgical removal of distant metastases, and palliative surgeries can enhance survival or alleviate symptoms, improving patients' overall quality of life.

If a pancreas operation necessitates spleen removal, living without a spleen is possible but may increase susceptibility to bacterial infections. Post-surgery, it's crucial to receive vaccinations, especially against pneumococcal infection, with periodic revaccination every 3–5 years per guidelines. In case of infectious diseases, informing the family doctor about the spleen removal is essential for appropriate antibiotic therapy. Additionally, regular monitoring of increased blood platelets after splenectomy is important to manage the risk of thrombosis, potentially requiring medication like aspirin.

The pancreas originates from two components that usually unite in the course of embryonic development. These components and the distinct ducts amalgamate into a single organ, with the anterior part (ventrally) migrating rearward. Disruptions in the fusion of the pancreas during embryonic development can result in pathological conditions.

1. Anulare pancreas

In the early developmental stage, the ventral migration of the pancreas causes a segment of the duodenum to encircle the papilla, impeding the passage of food.

2. Pancreas divisum

In this aberration, the two ductal systems of the pancreas fail to conjoin, while the actual tissue merges. Consequently, two ducts persist, opening into the small intestine. Secretions from the larger posterior (dorsal) segment are directed through the ductus Santorini via a "minor papilla." The smaller anterior (ventral) section releases its secretion into the ductus Wirsungianus via the "major papilla." Generally, this is inconsequential and only hinders pancreatic outflow if the minor papilla possesses an excessively narrow outflow duct in the papillary region, potentially causing acute or chronic pancreatitis.