What is a Whipple procedure (Pancreaticoduodenectomy)?

From the Guidelines

The Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation that removes the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, and the bile duct, and is primarily performed to treat cancerous tumors in the pancreas, particularly those located in the head of the pancreas, as well as tumors in the bile duct, duodenum, or the ampulla of Vater 1.

Overview of the Procedure

The procedure involves removing the affected structures and then reconnecting the remaining pancreas, bile duct, and stomach to the small intestine to restore digestive function.

• The Whipple procedure is considered a major operation with a lengthy recovery period, typically requiring 1-2 weeks in the hospital followed by 6-8 weeks of recovery at home.
• Patients often experience significant changes in digestion afterward, potentially requiring enzyme supplements to aid in food digestion and diabetes management if enough pancreatic tissue is removed.

Indications and Outcomes

The Whipple procedure is primarily indicated for the treatment of pancreatic cancer, particularly for tumors located in the head of the pancreas, as well as for tumors in the bile duct, duodenum, or the ampulla of Vater 1.

• Despite its complexity and potential complications such as infection, bleeding, and leakage from surgical connections, the Whipple procedure remains the standard treatment for pancreatic cancer when the tumor can be surgically removed, offering the best chance for long-term survival for eligible patients.
• The five-year survival rate following resection is approximately 10% 1.

Surgical Techniques and Considerations

Minimally invasive techniques can reduce the morbidity of pancreatectomies, but open surgery remains the standard of care due to insufficient data on oncological results 1.

• The International Study Group of Pancreatic Surgery (ISGPS) has recommended adhering to specific guidelines for specimen examination and microscopic tumor at the margin (R1) definition.
• 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.

From the Research

Overview of Whipple Procedure

• The Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical technique used to treat resectable pancreatic cancer and periampullary neoplasms 2.
• It involves the radical surgical resection of the tumor and is currently the only curative option for pancreatic cancer 2.

Surgical Technique and Outcomes

• The procedure involves the removal of the head of the pancreas, the duodenum, the gallbladder, and a portion of the bile duct 2.
• The study reports a mean operative time of 295 minutes and a mean blood loss of 450 ml, with a median blood transfusion of 1 unit 2.
• Postoperative complications include delayed gastric emptying, postoperative pancreatic fistula, and postpancreatectomy hemorrhage, with a perioperative mortality rate of 4.1% 2.

Clinical Considerations

• The procedure is typically performed on patients with resectable pancreatic cancer and periampullary neoplasms, defined by the absence of distant metastases and local tumor extension 2.
• The study highlights the importance of high-volume experienced centers in performing the Whipple procedure, with mortality rates below 5% 2.
• The use of internal pancreatic stent and end-to-side duct-to-mucosa pancreaticojejunostomy is reported, but no single technique has been shown to definitively prevent postoperative pancreatic fistula 2.