Pancreaticoduodenectomy or Whipple surgery is a complex operation involving removal of pancreas heads, duodenum (upper part of the small intestine), the gallbladder, and the pylorus, a portion of stomach, with associated lymph nodes. There are a few types of Whipple surgery:
- Standard with lymph node dissection; Radical with lymph node dissection; Pylorus preserving Whipple procedure.
Classic (radical) method includes removal of 40% of the stomach.
Who need Whipple procedure?
The operation is intended for those, who have:
- pancreas head cancer;
- duodenum cancer;
- cholangiocarcinoma (bile bottom end cancer)
- cancer of the ampulla (area where the bile and pancreatic duct enter into the duodenum).
Not all of pancreatic cancer patients are eligible for that operation. Only after thorough examination and testing, the diagnosticians could decide if it makes sense to perform that complicated treatment. It is important to investigate, whether the cancer had spread into the nearby tissues and organs, as the liver, lungs, and blood vessels. If it had, the procedure would not be much effective.
The treatment is also used for some non-oncologic diseases as chronic pancreatitis and benign tumors of the head of the pancreas.
The Whipple Operation
Pancreaticoduodenectomy is considered as more effective procedure for cure of pancreatic cancer than total pancreatectomy, with higher survival chances. The procedure is named in honor of MD Allen Whipple, who was first to perform this complex operation in America in 1935.
The operation consists of two parts:
- resection of the pancreas heads, upper part of the small intestine, and pylorus and gallbladder removal;
- reconstruction of the remaining digestive tract to preserve its ability to digest food and expel it.
The operation lasts for 7-8 hours. Sometimes additional treatments could be applied together with Whipple surgery, for example, intraoperative radiation therapy (IORT).
Remaining of the most demanding operations for pancreas cancer, Whipple procedure at the same time is a quite risky. But comparing the death rate in earlier development, which was as high as 25 % of patient who died during operations or shortly after, at present it reduced to the level of 4%.
Complications of the Whipple Procedure
There are a number of complications of the Pancreaticoduodenectomy both common and specific to this kind of operation. The common side effects are:
- Risk of infections
- Weight lost
The specific complications:
- Trouble with the stomach emptying itself after meals;
- Pancreatic fistula.
The patients, who undergone to Whipple Surgery experience permanent problems with digestion and need supporting medicine.
Survival Prognosis for Whipple Procedure
The five years survival prognosis for the operation is 20-25% with higher rate in those who have not any spreads into nearby lymph nodes. But taking into consideration that Whipple treatment is performed for initially severe condition with cancer in multiply organs, it is quite positive index.
Laparoscopic Whipple Operation
Nowadays, it has become possible a laparoscopic mode of Whipple operation. Using laparoscopy in such a difficult area is just starting to develop and available for selected patients. It is earlier to make prognosis as there is no any stats yet, but maybe in future the laparoscopic Whipple Procedure will be possible for wider range of people.
Qualification of the Surgeon
Whipple Procedure is a complex treatment both for patient and surgeon. The result is highly dependent on the surgeon qualification and experience, so before you decide going for the surgery, it is necessary to learn more about the medical center and he surgeon who is going to carry out the procedure. It is a significant part of success. There are a few German cancer centers who is able to provide a proper level of diagnostic and surgical skills. Before applying call and talk, and compare with the other clinic as you do a vital choice.