Only 20% of all pancreatic cancer patients are eligible to undergo the complicated and often risky Whipple procedure. With only 3% of all cancer patients being diagnosed with pancreatic cancer, the number of qualified Whipple procedure candidates is quite low. However, for those that are suitable for such a high-risk surgery, a positive outcome can often be expected.
Intended to remove tumors located solely in the head of the pancreas, and only available to those whose cancer has not yet metatasized, the Whipple procedure does not come without its fair share of procedure complications post-surgery.
Whipple Procedure Overview
Pancreatic cancer has one of the poorest prognoses when compared to other common cancer types. Due to its quiet growth and potential to spread throughout the body, it often goes undiagnosed for many years before finally showing symptoms.
Luckily, for those whose cancer is confined to the head of the pancreas and has not spread to nearby major blood vessels, the liver, lungs, or abdominal cavity, some may find the Whipple procedure to dramatically increase both the quality and length of their lives.
In general, the Whipple procedure will be performed by a specialized surgeon for a number of reasons:
- Pancreatic cysts
- Ampullary cancer
- Bile duct cancer
- Neuroendocrine tumors
- Small bowel cancer
- Trauma to the pancreas or small intestine
However, the most common reason for the Whipple procedure is to treat pancreatic cancer. Performed by a highly skilled surgeon, the procedure removes the cancerous portion of the pancreas that is located near the small intestine, as well as parts of the common bile duct, gallbladder, and sometimes the stomach. The surgeon then reattaches the remaining pancreas, small intestine, and bile duct so that the patient’s digestive system can continue to function properly.
Unfortunately, as with most major operations, there are certain procedure complications that can arise even with the most successful of surgeries.
Whipple Procedure Complications
Leakage of Pancreatic Fluids
The most common Whipple procedure complication patients experience is the leaking of pancreatic fluids from the incision where the surgeon has reconnected the pancreas and small intestine.
Due to ta poor healing process post-surgically, these leakage sites may require a drain to be inserted through the skin to allow for proper drainage until the suture heals all the way through. This external drain may be in place for several weeks after surgery and aids in preventing infection at the suture site.
25% of all patients will suffer stomach paralysis after the Whipple procedure. When the muscles or nerves of the stomach prevent proper grinding and emptying of the stomach, nausea, vomiting, and abdominal pain follow.
Though the stomach typically relaxes and returns to its normal functioning ability within 6-8 weeks, until then, the patient must receive nutrition via a feeding tube.
Related to stomach paralysis is the procedure complication called delayed-gastric emptying. This is when the stomach takes longer than normal to empty its contents into the intestines for further digestion. Lasting for only 7-10 days post-operatively, approximately 10% of Whipple procedure patients experience this complication. Here are some of the most common symptoms related to delayed-gastric emptying:
- Gastroesophageal reflux (GERD), also know as acid reflux or acid regurgitation
- Stomach pain
- Abdominal bloating
- Lack of appetite
- A feeling of fullness even after a small meal
Since a large portion of the pancreas is removed during the Whipple procedure, its ability to secrete the necessary enzymes required for digestion is decreased creating poor absorption of nutrients into the body.
25% of patients that undergo the Whipple procedure may need to take supplemental pancreatic enzymes, either short-term or long-term, to assist with digestive issues such as melabsorption, diarrhea, and excessive weight loss. Pancreatic enzymes come in both prescription and over-the-counter form, so it is best if you discuss with your pancreatic surgeon which one suits your individual needs the best.
The digestive system typically removes entirely approximately 3 months after the surgery. However, those who received radiation alongside their Whipple procedure are more likely to have to take supplemental pancreatic enzymes long-term.
Patients dealing with pancreatic insufficiency can expect the following symptoms:
- feelings of indigestion
- cramping after meals
- large amounts of gas
- foul smelling gas or stools
- floating or greasy/fatty stools
- light-colored, yellow, or orange stools
- frequent stools
- loose stools
- weight loss
Unfortunately, the long-term use of supplemental pancreatic enzymes can also cause their own side effects that a patient must deal with:
- abdominal pain
It is crucial that physicians determine a suitable nutrition plan for their patients post-operatively. In fact, sometimes a healthy diet after your Whipple procedure surgery can help alleviate some of the procedure complications and aid in the healing process.
This rare Whipple procedure complication can occur when too many insulin-producing cells are removed from the pancreas during surgery. Since insulin is require to maintain a normal blood sugar level in the average person, if too many insulin-producing cell are missing, the body will not be able to keep a proper balance thus thrusting in the onset of diabetes.
This is not something most patients who undergo the Whipple procedure have to worry about, however. If a patient has a normal blood sugar level before surgery, they are highly unlikely to come out of the surgery with any metabolic issues, including those related to diabetes.
The Whipple procedure, as effective as it is, still remains a highly specialized surgery that only qualified pancreatic surgeons such as Dr. Fraiman at The Liver and Pancreas Center should attempt. In fact, it is recommended by the American Cancer Society that only surgeons who perform approximately 15-20 Whipple procedures annually should be entrusted to perform one on your or your loved ones.
As a board certified pancreatic surgeon with over 20 years of experience treating patients with pancreatic disease, including pancreatic cancer, you can rest assured Dr. Fraiman has the expertise required to perform a Whipple procedure. In addition, with his patient-centered approach to treatment and recovery, you can expect quality care especially if you fall victim to any of the above-mentioned Whipple procedure complications.