The Whipple procedure (also known as pancreatoduodenectomy) is a surgical procedure used by doctors to treat patients diagnosed with pancreatic cancer. This procedure is also performed for patients with certain benign pancreatic disorders, including chronic pancreatitis
The Whipple procedure involves the removal of the head of the pancreas, part of the duodenum; which is the uppermost portion of the small intestine, a small portion of the stomach called pylorus, the gallbladder, and the lymph nodes near the head of the pancreas
Multiple clinical studies have shown that the Whipple procedure has better survival rates for patients diagnosed with pancreatic cancer, compared to chemotherapy or radiotherapy alone. It is potentially a curative option for patients with pancreatic cancer. However, not all patients are suitable for Whipples procedure.
Steps involved in the Whipple Procedure
Whipple procedure starts with the removal of not only the pancreas head, but also parts of the small intestine, gall bladder, bile duct, and part of the stomach. Next, the Pancreas Cancer Surgeon reattaches all the remaining parts of the pancreas and digestive organs, in order to facilitate recovery of normal activity of the digestive system.
The Whipple operation may be done traditionally (open) or laparoscopic, depending on several factors, such as the extent of disease, and the overall health condition of the patient.
Open Whipple Procedure
For a standard, open Whipple procedure, a transverse incision is made on the abdomen, and the abdominal cavity is first checked thoroughly for signs of metastasis. If the cancer has spread to other abdominal organs or invaded major vessels, the patient may be referred to a liver cancer surgeon for further evaluation.
But if no other organs are affected, the surgeon will then proceed to remove the head of the pancreas, the first part of the small intestine (duodenum), lower part of the stomach, gallbladder and bile duct. Typically, the surrounding lymph nodes will be removed for adequate staging of disease. Certain cases may require vascular reconstruction of major vessels if the tumour is close to the blood vessels, or if the tumour has invaded the blood vessels.
After removal of the pancreatic tumour, reconstruction will be required. This involves reconnection of the remaining parts of the stomach, pancreas and intestines to facilitate digestive processes.
Laparoscopic Whipple Operation
Laparoscopic Whipple operation may be offered to some individuals, where the organs are accessed and removed through several small incisions in the abdomen with the help of a monitor and a light-and-camera-assisted scope.
Compared to traditional open surgery, this method results in smaller incisions and less wound pain. It does, however, take several hours to perform, similar to open Whipple operation.
After the surgery, patients will typically be admitted to the high dependency (HD) or intensive care unit (ICU) overnight, and will stay in the hospital for a week or two for further observation and monitoring of progress. As patients gradually recover, they will be advised to take liquids and small meals. After 1 to 2 weeks, most patients are able to take food quite normally. Typically, most patients will be advised to take smaller amounts and more frequent meals in the initial few weeks of their recovery after Whipple operation. Pain control is important for post-surgery recovery and is usually accomplished with epidural anaesthesia or patient-controlled analgesia.
Most patients are able to sit out of bed after the first 1-2 days of surgery. There are some monitoring tubes and drains which will be progressively removed once not needed, as patients recover in the ward. Full recovery takes approximately a month for patients to get back to work.
Who May Undergo Whipple Procedure?
As the pancreas is surrounded by many vital organs and a network of blood vessels, pancreatic cancer rapidly spreads to other organs and tissues of the pancreas itself. When this occurs, it is difficult to perform the Whipple procedure for curative intent. For this reason, not all pancreatic cancer patients are eligible to undergo the Whipple procedure. It is mainly intended to help patients with cancer limited to the head of the pancreas only
Complications associated Whipple procedure
As in any surgical procedure, complications may occur.
Below is a list of complications associated with the Whipple procedure:
- Pancreatic fistula with leakage from the pancreas
- Wound infection or delayed wound healing
- Impaired sugar control or diabetes as a consequence of removal of the pancreatic head
- Wound pain
- Weight loss after the procedure (most patients will lose 10-15% of their current weight)
- Digestive disorders, such as diarrhea, improper digestion, and delayed bowel movements
If you have been recently diagnosed with pancreatic cancer, consult your surgeon regarding the Whipple procedure.