What is it? What are the complications? And what is the prognosis?

The Whipple Procedure Explained

The Whipple procedure is more than just an alternative for the mouthful word pancreaticoduodenoctomy.

It is more than a major surgical procedure to remove a portion of the pancreas, bile duct, gallbladder, duodenum and stomach.

It is a ray of light amidst the darkness that is pancreatic cancer.


For anyone going through pancreatic cancer, the physical and emotional burden of the disease can be too much to handle.
Often, the lack of information that is both accurate and easy to understand can weigh down an already troubled person.

This site helps patients, their families and loved ones to understand the Whipple procedure, survival rate, complications and possible prognosis.

The pancreas

The pancreas is an organ in the human body that plays parts in the digestive and the endocrine system. It has the islets of Langerhans, which produce hormones for other body functions and acinar cells, which produce enzymes for the digestion of food and the absorption of nutrients.

The pancreas with surrounding organsThe pancreas and its parts lie in close proximity with other organs inside the abdominal cavity. The head of the pancreas rests on the arc of the duodenum, the body is behind the stomach and the tail is in contact with the spleen. Most blood vessels run across, behind or along the pancreas.

The dual role the pancreas plays and the approximation of its parts to other organs make pancreatic diseases complicated, difficult to manage and sometimes, fatal.

The reality that is pancreatic cancer

As much as you wish it to be a nightmare which is gone when you wake up, pancreatic cancer is a reality.

Pancreatic cancer is a malignant tumor, which originates from abnormal growth patterns and the proliferation of cells in the pancreas. The growth of cells exceeds and violates the boundaries of the normal tissue around it. If this is seen in the exocrine component of the pancreas, it is known as adenocarcinoma and it accounts for 95% of cases. The remaining 5% is from the islet cells.

Pancreatic cancer often has poor prognosis: rates for all stages of pancreatic cancer combined are 25% 1-year survival and 6% 5-year survival.
The 5-year survival rate for a localized disease is 20% while the average survival for locally advanced and metastatic disease is about 6-10 months.

When to consider a Whipple procedure

The Whipple procedure is a curative surgical treatment for exocrine pancreatic cancers involving the head of the pancreas. It is only performed if the neoplasm is localized and did not invade neighboring structures or metastasize.

Sadly, less than 20% of cases are localized upon diagnosis. The procedure can only be performed for this minority.

What exactly happens in a Whipple procedure

In short, the surgery involves removal of the site of the neoplasm, the head of the pancreas, and the surrounding organs: the curve of the duodenum, distal half of the stomach, gall bladder, cystic duct, common bile duct and regional lymph nodes.

Reconstruction is done to preserve the continuity of the digestive tract and it involves creation of a bypass for food to pass from stomach to the jejunum and the attachment of the hepatic duct to the jejunum to allow passage of digestive juices from the pancreas and bile from the liver into the digestive tract.

A more elaborate, yet easy to understand explanation can be seen in the video below.

Procedural Complications and Risks

The Whipple procedure has been refined from the original two step-processes to a one step-operation. Although modern health care technology has greatly improved the procedure and reduced the mortality rate to 5%, a Whipple surgery is still a major surgical procedure with risks and complications.

Possible immediate complications are:

  • Anesthesia-related effects
  • Chest infection and/or breathing problems
  • Bleeding during or after operation
  • Wound infection
  • Blood clots in extremities
  • Anastomotic leak
  • Delayed emptying of stomach

After the surgery, patients stay in the hospital for 1-2 weeks. Close monitoring of vital signs and possibility of complications is vital. Patients are fed IV fluids to give time for the digestive tract to heal before it is stretched by food. Painkillers are given and other measures of care are provided.

Prognosis

The Whipple procedure, among other treatment options available, gives the patient the best chances of cure. The surgery is aimed at the complete elimination of the source, that’s why a wide area surrounding the neoplasm is removed.

Without surgery, only 6% of patients with pancreatic cancer can survive up to 5 years. A successful surgery increases this by 10-40%. On average, the survival rate is 20%.

The prognosis after the procedure is determined by many factors. And even if the visible tumor is successfully removed, some cancer cells are not discovered prior and during the surgery. It is possible that cancer cells have spread to other organs and start to grow after the procedure. To counteract this and increase the chances of a better prognosis, patients are advised to undergo chemotherapy and/or radiation after surgery.

What happens after

The pancreas is a vital organ, both for digestion and hormonal balance. And because of decreased digestive enzyme production, the Whipple procedure could cause malabsorption. Dietary adjustments should therefore be taken into account, and some patients may even need to take pancreatic enzyme supplements.

Another long-term consequence could be diabetes because insulin, the primary regulator of blood sugar, is produced by the pancreas. It’s not uncommon for a non-diabetic to be diabetic after surgery, and patients with diabetes prior to the surgery may even require additional medication or insulin after.


But remember, the Whipple procedure has cured and prolonged the lives of many patients. Surgeons, oncologists and many specialists have made multiple refinements to the techniques of the procedure to give patients better chances in their fights against pancreatic cancer.

So don’t be kept in the dark by fears.
But don’t get blinded by false hopes either.

Make sure to completely understand the procedure, and make informed decisions to prepare yourself for the battle.