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On This Page
- What Is a Whipple Procedure?
- Who Is Eligible?
- Who Is the Best Surgeon for a Whipple?
- Questions to Ask the Surgeon
- What Happens During the Procedure?
- What Happens After Surgery?
- Are Other Treatments Given with the Whipple Procedure?
- Long-Term Effects
What Is a Whipple Procedure?
The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.
Who Is Eligible?
If a tumor is in the head of the pancreas, has not spread to other areas of the body and can be removed (resected) surgically, the Whipple procedure may be attempted. Approximately 15 to 20 percent of patients with pancreatic adenocarcinoma (the most common type of pancreatic cancer) have surgically resectable tumors.
About 30 to 50 percent of patients who are eligible for surgery are told they are ineligible. The Pancreatic Cancer Action Network strongly recommends you see a surgeon who performs a high volume of pancreatic surgeries (more than 15 per year) to determine eligibility.
Determining a patient’s eligibility for surgery is not always easy. Even sophisticated imaging tests may not provide perfect information. In some cases, despite testing before surgery, the surgeon may find during the procedure that the cancer has spread or cannot be removed. Therefore, the planned operation cannot be completed.
Who Is the Best Surgeon for a Whipple?
Pancreatic surgery is very complicated. Data show high volume surgeons at high volume hospitals have higher success rates and fewer complications. The Pancreatic Cancer Action Network strongly recommends you have a high volume pancreatic surgeon (more than 15 surgeries per year) perform the surgery.
Patient Central can provide more information, including a list of institutions and doctors who perform a high volume of pancreatic surgeries.
Questions to Ask the Surgeon
- Can my tumor be removed through surgery? Why or why not?
- How many pancreatic surgeries have you performed? How many in the past year?
- How many pancreatic surgeries are performed at your hospital every year?
- What are the possible complications of pancreatic surgery?
- How long should I expect to be in the hospital recovering after pancreatic surgery?
- Would you be able to recommend another experienced surgeon for a second opinion?
What Happens During the Procedure?
In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, the duodenum, a portion of the stomach and surrounding lymph nodes. The surgeon then reconnects the remaining pancreas and digestive organs.
In some cases, patients may undergo a modified version of the Whipple procedure, which keeps the entire stomach and the stomach valve called the pylorus. This is called a pylorus-preserving Whipple.
Both types of surgery typically take 5-7 hours.
What Happens After Surgery?
The patient stays in the hospital for 8-10 days after a Whipple procedure. During this time, doctors watch for complications, and the patient slowly begins drinking and eating again.
In the days following surgery, doctors run extensive tests to see if all the cancer was removed and if any cancer cells were in the lymph nodes.
After a Whipple procedure, the most common complication is delayed gastric emptying. This means the stomach takes too long to empty its contents. Usually, after 7-10 days, the stomach begins to empty well enough to allow healing. If delayed gastric emptying continues, the patient may require feedings through a feeding tube or vein for several weeks.
The most serious potential complication of a Whipple procedure is abdominal infection due to leakage where the pancreas is connected to the small intestine. This is referred to as a pancreatic leak or pancreatic fistula. This occurs in about 10 percent of patients and is usually controlled with a combination of draining tubes and antibiotics. Many of these patients require nutritional support.
Are Other Treatments Given with the Whipple Procedure?
Sometimes patients receive treatment before surgery. Called neoadjuvant therapy, this is generally chemotherapy, radiation therapy, or both.
Often patients receive adjuvant therapy, or treatment that is given after surgery. The goal is to kill any small cancer cells that may still be present to prevent the tumor from coming back.
Clinical trials may be available for pancreatic cancer patients seeking neoadjuvant or adjuvant therapy.
The Whipple procedure may cause challenges, including digestive difficulties, for a long time.
- It can take a patient anywhere from a few months to a year to feel relatively “normal” again.
- It takes time for the digestive system to start working again, and some patients must make permanent diet changes to reduce symptoms such as diarrhea, gas and stomach pain.
- Many patients also take pancreatic enzymes to help digest food properly.
Patient Central can provide resources and information about challenges after surgery, including diet and nutrition information.
We’re Here to Help
For free, in-depth and personalized resources and information on pancreatic cancer, contact Patient Central.
The Pancreatic Cancer Action Network would like to thank Kathleen Wagner and support from the Hamill Foundation and the Pickelner Fund for Pancreatic Cancer Research at MD Anderson Cancer Center for the illustrations provided on this page.