Understanding the Whipple Procedure for Pancreatic Cancer

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The most common type of pancreatic cancer is known as adenocarcinoma of the pancreas. Other cancers that originate in the pancreas can include neuroendocrine tumors and lymphoma. The treatment and prognosis are very different across these different types. For adenocarcinoma of the pancreas, surgery is one option, and although it may be stressful hearing the word "surgery," this option does offer the potential for long-term survival and cure.

The risk of developing pancreatic cancer over a lifetime is around 1.5 percent, making it the 12th most common cancer in the United States. Unfortunately, the prognosis for pancreatic cancer remains dismal despite progress in the treatment of many other cancer types. This is due, in part, to the fact that by the time symptoms are apparent, it is oftentimes already advanced. Survival following five years from diagnosis is generally under 10 percent. Total surgical removal of the cancer, although aggressive, is the only current measure that offers long-term survival and cure.

Not everyone diagnosed with pancreatic cancer is a candidate for surgery. In fact, only for the minority of newly diagnosed people is surgery indicated at all. There are also factors that may preclude someone from having surgery.

Understanding the Whipple Procedure

The type of surgery performed depends on several factors, one the most important of which is the location of the tumor on the pancreas.

The pancreas is grossly divided into the head, neck, body, and tail. The most common location for an adenocarcinoma to form in the pancreas is in the head.

For those who are candidates for surgery and have the tumor in the head of the pancreas, the most common approach is a surgery known as the Whipple procedure.

It is named after Dr. Allen Whipple, an American surgeon who served to refine the surgery in the early 1900s. It is formerly known as a pancreaticoduodenectomy.

The Whipple procedure a major surgery in the sense that it not only removes the head of the pancreas with the tumor, but it also involves the removal of part of the stomach, the first part of the small bowel, bile duct, gallbladder, and local lymph nodes. Why such aggressive removal? This extensive removal of tissue is an effort to remove all of the tumor and to offer a chance for a cure from the cancer.

The body and tail of the pancreas are left in an attempt to maintain proper endocrine and exocrine functions. Endocrine functions include the production of insulin and glucagon, essential hormones in the regulation of the body's blood sugar. Exocrine functions include the production of enzymes such as lipase and amylase which aid digestion by breaking down fats, carbohydrates, and proteins.

Variations of the Whipple Procedure

There are several variations on the classic Whipple procedure that preserve more of the stomach and first part of the small bowel, most commonly known as pylorus-preserving pancreaticoduodenectomy. These procedures are done to help minimize certain postoperative complications.

For example, removal of part of the stomach and the first part of the small bowel can result in dumping syndrome, a condition that can result in significant diarrhea shortly after eating. It can also decrease the chance of bile reflux, a condition where the bile goes the wrong direction and enters the stomach resulting in inflammation and discomfort.

If need be, Selected centers are able to perform even more extensive procedures. This includes resecting certain blood vessels if they are involved with the cancer.

Total Pancreatectomy

Total pancreatectomy is essentially the same as a Whipple procedure, but differs in that the entire pancreas is removed.

This is done when entire removal of the pancreas is necessary to remove all the visible tumor. When this procedure is performed, all pancreatic function is, of course, completely lost. There is no endogenous production of insulin, glucagon, or digestive enzymes. Diabetes is inevitable and insulin therapy and enzyme replacement are necessary following surgery.

What to Expect

Just like most other major surgeries, a general anesthetic is used. No food or drink should be consumed the night before surgery. As the surgeon directs, a clear liquid diet may be instituted a day or two before surgery. Most surgeries carry the risk of developing a blood clot and the risk is especially high in surgeries for pancreatic cancer. As a result, compression devices are typically placed on the legs during and following surgery to aid in the circulation of blood. An anticoagulant may be administered as well.

Understandably, undergoing such a surgery is stressful. Reach out to your healthcare team and friends and family for support in preparing and coping.