Before explaining the Whipple procedure, it may be helpful to explain the anatomy of the pancreas and its surrounding area.
The pancreas is responsible for producing enzymes necessary to the digestive process and even produces insulin and other hormones.
The pancreas has four “parts”:
- The head
- The neck
- The body
- The tail
It is connected to the upper part of the small intestine (duodenum) by the pancreatic duct. The liver, intestines, spleen, gallbladder and stomach surround the pancreas.
The Whipple procedure, or pancreaticoduodenectomy, is a surgical operation that removes or resects the head of the pancreas and portions of the common bile duct and duodenum.
In most Whipple procedures, the gall bladder, nearby lymph nodes, and a portion of the stomach called the pylorus are also removed. The pancreatic surgeon then reconstructs, or reconnects these organs so that the digestive system can function as necessary.
While it is the most common surgical procedure for pancreatic cancer patients, it is also considered to be one of the most complex medical procedures, and therefore should be performed by an experienced pancreatic surgeon in a specialized center, like the Liver and Pancreas Center at St. Joseph Medical Center.
Am I A Candidate for the Whipple Procedure?
The Whipple procedure is intended for patients with some pancreatic cancers and some patients with chronic pancreatitis.
Because of the nature of the surgery, the Whipple procedure is intended to remove tumors that have formed in the head (widest part) of the pancreas or tumors arising from the common bile duct or duodenum. Typically, the procedure is only performed on patients whose cancer has not metastasized to other areas of the body.
Only about 20% of pancreatic cancer patients are considered eligible for the Whipple procedure. You should speak to your oncologist and pancreatic surgeon to see if the Whipple procedure is a treatment option for your cancer.
What Can I Expect During and After a Whipple Surgery?
If you and your doctor have decided that you are good candidate for the Whipple procedure, you will be placed under general anesthesia during surgery and you will be given an epidural to help manage any pain.
The average time needed to complete a standard Whipple procedure is between three to eight hours, depending on the surgeon and if any complications arise during the operation.
After surgery, you can expect to spend your first night in the intensive care unit, just as a precaution. Then you can expect to stay at the hospital for an additional seven to ten days. During your first few days, you will be on a feeding tube.
It may take a few months to fully recover from the procedure. During that time, depending on the post-op treatment plan developed by your doctors, you can expect to feel fatigued and to feel pain near the incision site.
You may also find that your appetite has decreased. To help your digestive system recover more quickly, you will want to start your oral diet with clear liquids and slowly progress towards your normal diet. However, you will want to refrain from eating greasy and fried foods.
Your doctor may recommend that you take pancreatic enzymes or anti-acids as needed.
You may want to keep a journal after surgery. Record details of your diet, your daily weight, and any other information your doctor may feel is important. This will help your doctors regulate and manage your long-term treatment.
How Will It Help Me?
Because pancreatic cancer is hard to detect early on, most patients are given a life expectancy of less than 5 years after diagnosis. However, patients who undergo successful Whipple procedures have a greater chance of living longer than five years. It can increase your chance of living beyond five years to 20-40%.
Why Is the Whipple Procedure Considered Complex?
The pancreas lies deep within the body and is integrated with several other organs.
The pancreas is also connected to three major supplies of blood to the digestive system:
- Portal vein,
- Superior mesenteric artery
- Mesenteric vein
In addition to being surrounded by vital and delicate parts of the digestive system, some patients have variations of the arrangement of vessels and ducts related to the pancreas.
Because of the intricate placement of the pancreas, a pancreaticoduodenectomy, or Whipple surgery, is considered to be a complex operation that should only be performed by a surgeon that has considerable experience performing Whipple procedures.
What Complications Can Occur After Surgery?
There are two major complications that can occur after a pancreaticoduodenectomy, or Whipple procedure.
The most common is abdominal infection due to leakage from the pancreas. This occurs in only about 10% of post-op patients. If this occurs, tubes will be placed in the patient in order to drain the enzymes from the body.
Another complication that may arise post-operation is called delayed gastric emptying. This occurs when the stomach takes longer than normal to empty its contents and can last from seven to ten days. Again, only about 10% of patients who undergo the Whipple procedure at St. Joseph’s experience this complication.
Rarely, some patients experience long-term digestive problems, significant weight loss, and the onset of diabetes.
Although rare, because these complications can occur, the American Cancer Society recommends that Whipple procedures only be performed at highly specialized cancer centers.
Choose Dr. Fraiman and St. Joseph Medical Center in Baltimore, MD
Dr. Mark Fraiman was named “America’s Top Surgeon” in 2014 by Guide to America’s Top Surgeons Magazine.
Dr. Fraiman has over 20 years of experience as a pancreatic surgeon and is the Research Director of the University of Maryland’s St. Joseph Medical Center’s Liver and Pancreas Center.
Dr. Fraiman is considered an expert on liver and pancreatic conditions and he has the experience and training to successfully perform the Whipple procedure. Dr. Fraiman treats his patients with pancreatic cancer using a multidisciplinary, holistic, and patient-centered approach. Click here to view testimonials from his patients.
If you or someone you love is considering the Whipple procedure to treat pancreatic cancer, contact Dr. Mark Fraiman today.