Whipple Procedure

The Whipple procedure is one of the most involved surgical procedures within general surgery—it more or less defines major surgery. This procedure, also known as pancreaticoduodenectomy, is the primary surgical treatment for cancer of the pancreas and is sometimes used for small bowel cancer. Despites being the primary surgical treatment, only about 20 % of patients with pancreatic cancer will have resectable disease, i.e. be a candidate for a pancreaticoduodenectomy.

The Whipple procedure involves the removal of the head and neck of the pancreas (where most pancreatic tumors form), the gall bladder, part of the stomach, and a large portion (if not all) of the first part of the small intestine called the duodenum. Surrounding lymph nodes may be dissected and tested for the presence of cancer cells during a Whipple. After the tissue is removed, the remaining pancreas is connected to the stomach and small bowel and bile from the liver drains directly into the small intestine since the gall bladder has been removed.

 

 

Because of the extensive amount of tissue that is removed in Whipple procedure, most are done in the traditional, open way. In other words, a large incision is made in the abdomen through which the necessary dissections and reattachments are made. Performing a Whipple procedure by laparoscopy, that is, through a series of small incisions rather than a large incision, is extremely technically challenging. Some surgical centers such as at the Mayo Clinic and Johns Hopkins University offer laparoscopic Whipple procedures in carefully selected patients.

 

Since the pancreas is the organ of the body that produces insulin and insulin is essential for glucose (sugar) absorption by cells in the body, a Whipple procedure can lead to a form of diabetes in some patients. In those that are affected, the diabetes can be treated by insulin injections. The pancreas is also a major producer of digestive enzymes so when it is surgically removed, it can cause several changes in digestion. Patients that have undergone a Whipple procedure can expect to lose up to seven percent of the pre-surgery weight from changes in nutrient absorption and digestion. This weight loss is usually above the amount that was lost as a result of the pancreas cancer itself. Most of the digestive enzymes that are lacking after a Whipple procedure are available orally.

 

Even in skilled hands, the mortality rate from the Whipple procedure and progression of pancreatic cancer is relatively high. Pancreatic cancer can be a devastating disease because diagnosis is often delayed, spread is extensive, and even the broad surgical removal of organ and tissue during a Whipple procedure is not always enough to affect a cure. It is important to have a frank discussion with your oncologist and surgeon about realistic expectations. Fortunately advances in diagnosis and treatment have increased survival rates for this horrible disease. Newer surgical approaches such as the central pancreatectomy can leave patients with more functional tissue than the Whipple procedure while removing pancreas tumor and surrounding tissue. Like the laparoscopic Whipple, these newer surgical approaches are not always available at all surgical centers and performed by all general surgeons. If you have been diagnosed with pancreatic cancer it is important to have a physician that you trust explain all of your treatment options, even if some options are only available at major surgical centers.