Pancreas
Chronic Pancreatitis
Cystic Neoplasms
Robotic Pancreatic Surgery

Overview: Pancreatic Conditions

djt pancreas 1 1024x1024The pancreas balances the body’s blood sugar by producing insulin, which is the enzyme that controls blood sugar levels. The pancreas is vital for the digestive system since it produces enzymes that help break down food and insulin which regulates blood sugar levels. Many types of pancreatic issues can develop, ranging from diabetes to cancer. Pancreatic cancer develops when a tumor grows in the pancreas. Pancreatic cancer, like any other cancer, starts from one or a few cells that divide uncontrollably and form a tumor. The tumor cells stay localized to the pancreas initially but can spread to lymph nodes or other organs (liver, abdominal cavity, lungs) as cancer becomes more advanced. The exact reasons for DNA damage of pancreatic cells are not known, but several factors have been established to raise the risk of a person developing pancreatic cancer such as obesity, smoking, environmental exposures, and genetics.

Pancreatic cancer can be very aggressive, progressing from stage I (localized disease) to stage IV (metastatic disease) in one year or less. It also is very difficult to diagnose early due to the lack of screening tests.

The symptoms of pancreatic cancer are often vague and non-specific. How to diagnose pancreatic cancer early is very challenging. For this reason, only 20% of pancreas patients with pancreatic cancer are diagnosed at an early stage. Symptoms of pancreatic cancer include: jaundice, itching, weight loss, loss of appetite, diarrhea, new-onset diabetes, and vague abdominal pain. These symptoms are discussed in more details:

  • Pain – The growing tumor presses against the surrounding tissues and nerves, causing discomfort as it becomes more significant. The pain becomes severe when cancer develops beyond Stage III. In the early stages, the pain is relieved by strong prescription painkillers, which block the celiac plexus block nerves from sending pain signals to the nervous system.

  • Weight loss - The discomfort in the stomach area, nausea, and vomiting contribute to making it difficult to eat and retain nourishment. The production of digestive fluids and enzymes which is needed for digestion and absorption of nutrients hampers, leading to rapid weight loss.

  • Jaundice – In some cases, the tumor blocks the bile duct, preventing the stomach's normal release of bile. The high levels of bile in the liver cause jaundice, which shows in the yellowing of skin, eyes, and nails.

  • Poor bowel movement – The pancreatic tumor can press into the small intestines (duodenum), making it obstructed. It slows down the normal flow of food in the digestive tract, adding to stomach discomfort, loss of appetite, and constipation.

Pancreatic cancer

djt pancreas 2 2048x2038How to diagnose pancreatic cancer early? Pancreatic cancer is usually diagnosed after a physician suspects the diagnosis and orders a CT scan to evaluate conditions of the pancreas or discovered incidentally on a CT scan obtained for other reasons. When a pancreatic mass is discovered on imaging a thorough workup is performed to establish the diagnosis, stage the disease, and determine if the tumor is resectable surgically. The additional tests employed include: bloodtests, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and sometimes MRI or additional CT scan in hospital. After the workup is complete the case is discussed in a multidisciplinary tumor board where robotic pancreatic surgeon, oncologists, radiation oncologists, radiologists, and genetic counselors discuss each case and determine the proper treatment strategy. When pancreatic cancer is detected early, and if the disease is localized, it can be treated with curative intent.

Treatment involves a combination of surgery, chemotherapy, and sometimes radiation therapy. Due to the aggressive biology of pancreatic cancer, treatment with surgery or chemotherapy alone is inadequate and a combination of the two is always necessary. It is of utmost importance to select the best pancreatic surgeon who has specialized training in pancreatic surgery when embarking on treatment for pancreatic cancer. Pancreatic cancer is treated by complex surgery and difficult in patients. Multiple studies have shown that outcomes in pancreatic surgery are better when performed by surgeons with specialized training in Loveland Co. who also perform a high volume of cases. Dr. Tierney is a fellowship-trained hepatopancreatobilairy (HPB) surgeon who performs a high volume of pancreatic surgery and has a reputation for success. Dr. Tierney is also a top robotic surgeon for pancreas in Denver, CO., who performs complex minimally invasive pancreatic surgery using new robotic technologies as dictated by the extent of the disease.

Related Procedures

Whipple procedure

This procedure is also known as a pancreaticoduodenectomy. It involves removing the head of the pancreas, the duodenum, the distal bile duct, and the gallbladder. This procedure is performed when the tumor is located in the head of the pancreas. The Whipple procedure is performed through both open and robotic approaches.

Distal pancreatectomy

This procedure is done when the cancer is confined to the tail or body of the pancreas. For pancreatic cancer, the spleen is removed with the tail of the pancreas so that all of the surrounding lymph nodes are removed with the tumor. This procedure is performed both open and robotically by Dr. Tierney.

Total pancreatectomy

This procedure removes the whole pancreas together with the small intestines, gallbladder, and spleen. It is possible to live without the pancreas but one must depend on insulin shots and oral enzymes for a lifetime.

Pancreatic robotic surgeon

djt pancreas 3 1024x683The traditional method of pancreatic surgery involves cutting open the stomach area to get to the pancreas. It enables the surgeon to see the surrounding tissue and organs. The main drawback of open surgery is trauma.

A new way of performing pancreatic surgery is by using a robot in a robotic-assisted procedure using a precise cut by a surgeon controlled robot. This type of pancreatic cancer surgery can be done with different types of pancreatic cancers, including benign masses, neuroendocrine tumors, pancreatic adenocarcinoma, cystic tumors, and chronic pancreatitis. The best pancreatic surgeons are knowledgeable and skilled with these techniques.

The robot has a 3D camera attached to the robotic arm, through which the surgeon can see the pancreas and surrounding organs. The robotic arm inserts via a small incision (about half an inch) on the side of the stomach. The pancreatic surgeon then guides the robotic arm to excise the tumor and pull it out. Robotic surgery has become the preferred treatment in pancreatic surgery because there is less trauma, lower blood loss, and tissue injury. The patient takes a shorter time to recover and can move on to chemotherapy.

Before surgery

The steps followed before surgery are:

  • An office visit for surgical consultation where a comprehensive history and physical exam is performed.
  • Completion of clinical tests for workup and staging.

  • Multidisciplinary tumor board review for an expert recommendation regarding treatment strategy.

After surgery

The type of surgical procedure done determines the kind of post-surgery care required. Post care after a surgical operation involves:

  • A brief admission to the ICU is sometimes required for complex procedures such as a Whipple Procedure Recovery then continues in the hospital ward for another three to five days. Procedures performed robotically typically have a faster recovery and can expect discharge from the hospital one or two days earlier than open procedures.

  • The goals of postoperative care include: monitoring for and intervening on any complications that can occur, awaiting the resumption of normal bowel function, maintaining adequate hydration and nutrition, physical and occupational rehabilitation, and providing adequate pain control. Once these measures are met, the patient will be discharged from the hospital. Post-operative follow-up will be scheduled one week from discharge with Dr. Tierney.

Why should you choose Dr. Tierney for treatment of the Pancreas?
joshua tierney 1

Why should you choose Dr. Tierney for the treatment of the Pancreas?

Pancreatic cancer must be treated by a multidisciplinary team of cancer specialists Dr. Joshua S. Tierney, MD is a fellowship-trained Hepatopancreatobiliary (HPB) surgeon with a wide breadth of experience in complex pancreatic surgery. In addition, he is one of the few best pancreatic surgeons in the country who performs robotic pancreatic surgery. He believes in a multidisciplinary expert team approach that requires personalized attention, extensive consultation & care with other medical professional’s directions to develop a treatment plan that is on the cutting edge of cancer care.

Dr. Tierney received a Bachelor of Science Degree from Purdue University in 2006, a Doctor of Medicine Degree from the Indiana University School of Medicine in 2011, completed his residency in General Surgery at Vanderbilt University, and completed his Hepatopancreatiobiliary (HPB) and Therapeutic Endoscopy Fellowship at the University of Louisville.

Do you have a medical concern that would require Dr. Tierney’s attention? Schedule an appointment by calling 970-221-5878.

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