From the Guidelines
The Whipple procedure is the most effective treatment for cancerous tumors in the head of the pancreas, and it should be performed with the goal of achieving an R0 resection, as this is associated with improved long-term survival 1.
Overview of the Whipple Procedure
The Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation that involves removing the head of the pancreas, the first portion of the small intestine (duodenum), the gallbladder, part of the bile duct, and sometimes a portion of the stomach.
Key Considerations
- The procedure carries risks including bleeding, infection, and leakage from the surgical connections, but it offers the best chance for long-term survival for patients with pancreatic cancer 1.
- Dissection of the right hemi-circumference of the SMA to the right of the coeliac trunk is recommended to obtain a good medial clearance and to improve the rate of R0 resection 1.
- In the event of vein involvement, complete venous resection (PV or SMV) followed by reconstruction to obtain R0 resection is possible, but it is associated with a lower rate of R0 resection and poorer survival 1.
Post-Operative Care
- Recovery from a Whipple procedure typically requires a hospital stay of 7-10 days, followed by several weeks of recovery at home 1.
- Patients often experience significant changes in digestion afterward, potentially requiring pancreatic enzyme supplements to aid in food digestion 1.
Mortality and Morbidity
- Despite its complexity and potential complications, the Whipple procedure has become safer over time with mortality rates below 5% at specialized centers where surgeons perform the operation frequently 1.
- Arterial resections during pancreatoduodenectomy are associated with increased morbidity and mortality, and are not recommended 1.
Quality of Life
- The Whipple procedure can significantly improve the quality of life for patients with pancreatic cancer by removing the tumor and relieving symptoms such as pain and jaundice 1.
- However, patients may experience long-term side effects such as diabetes, malabsorption, and weight loss, which can impact their quality of life 1.
From the Research
Overview of the Whipple Procedure
- The Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical technique used to treat resectable pancreatic cancer and periampullary neoplasms 2.
- The procedure involves the radical surgical resection of the tumor, which is the only curative option for pancreatic cancer 2.
- The prevalence of pancreatic cancer increases with age, and risk factors include smoke and tobacco usage, alcohol consumption, coffee, history of diabetes, or chronic pancreatitis 2.
Surgical Technique and Outcomes
- The surgical technique involves an end-to-side duct-to-mucosa pancreaticojejunostomy with the routine use of an internal pancreatic stent 2.
- The mean operative time for the Whipple procedure is approximately 295 minutes, with a mean blood loss of 450 ml and a median blood transfusion of 1 unit 2.
- Postoperative complications include delayed gastric emptying, postoperative pancreatic fistula, and postpancreatectomy hemorrhage 2, 3.
- Perioperative mortality rates are around 4.1% to 5% 2, 3.
Imaging and Complications
- Postoperative imaging with CT is essential to exclude complications and identify recurrence after the Whipple procedure 4.
- Accurate interpretation of CT examinations requires knowledge of the type of surgery performed and the normal appearance of the abdomen on CT following the Whipple procedure 4.
- Complications such as delayed gastric emptying, postoperative pancreatic fistula, and postpancreatectomy hemorrhage can be identified on CT scans 4.
Risk Factors and Outcomes in Older Adults
- Older adult patients undergoing the Whipple procedure have higher rates of comorbidities, such as diabetes mellitus, congestive heart failure, and hypertension 3.
- Older adults also have higher rates of postoperative mortality, pneumonia, transfusions, and delayed gastric emptying compared to younger adults 3.
- Multivariate logistic regression revealed that older adult age and hypertension are significantly associated with increased odds of postoperative myocardial infarction 3.