Pancreatoduodenectomy (the Whipple Procedure)
Pancreatoduodenectomy is commonly referred to as the Whipple procedure and is named after Allan Whipple, MD, a physician who perfected the surgery in the 1930s.
The Whipple procedure is the most common operation to remove pancreatic cancers. The Whipple procedure may also be used to treat some benign pancreatic lesions and cysts and cancers in the bile duct and beginning part of the small intestine (duodenum).
Whipple Procedure and Pancreatic Cancer
At the time of diagnosis, pancreatic cancer is often found to have already metastasized (spread to other organs) and these patients will not benefit from surgical removal of their primary tumor. Surgery can be performed as a potentially curative measure if the cancer is contained within the pancreas and has not spread to blood vessels, distant lymph nodes or other organs. (Local lymph nodes are not an exclusion to surgery. Distant lymph nodes generally do preclude surgery.) This treatment option should be discussed with your physician to see if it is a viable option. The type of operation performed for removal of pancreatic cancer is based on the location of the tumor. For tumors of the head and neck of the pancreas the Whipple procedure is performed. Tumors that grow in the body and tail of the pancreas are removed through a surgery known as a distal pancreatectomy.
The goal of the Whipple procedure (pancreatoduodenectomy) is to remove the head of the pancreas. This is where most tumors occur. Because the pancreas is so integrated with other organs, the surgeon must also remove the first part of small intestine (duodenum), the gallbladder, the end of the common bile duct and sometimes a portion of the stomach. In the reconstruction phase of the operation, the intestine, bile duct and remaining portion of the pancreas are reconnected.
A laparoscopic Whipple procedure may be offered to select individuals. The laparoscopic Whipple procedure is performed through small incisions in the abdominal wall. A laparoscope, a long thin tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using specially designed surgical instruments placed through the remaining incisions, guided by the laparoscope images shown on a monitor in the operating room. Conventional surgeries require a longer incision and wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce blood loss and risk infection for the patient.
Complications and Outcomes
The most common post-surgical complication of pancreatoduodenectomy is leaking of pancreatic juices from the incision. If this occurs, a drain may be inserted through the skin to allow drainage for several weeks after surgery. Weight loss is another frequent complication of the Whipple procedure. Diabetes is a potentially serious concern for some people (a minority) after surgery. In general, although many people do very well after the Whipple procedure, some develop immediate complications that affect their quality of life.
How to select the physician and medical center?
Questions to ask:
- How many of these operations do you (and your group) perform each year?
- What are your complication rates? How many of your patients survive the operation?