Candidacy for the Whipple Procedure

A resectable tumor contained entirely within the pancreas and localized within the head of the pancreas is a perfect candidate for a Whipple Procedure.
The head of the pancreas is surrounded by important blood vessels – the superior mesenteric vein and artery, which supply blood to the intestine and liver. The pancreatic cancer should not invade these blood vessels to qualify for surgery. This is determined via high quality imaging like CT scan with endoscopic sonography.

The Whipple Procedure for Pancreatic Cancer

The operation involves the removal of the head of the pancreas, which contains the tumor. Usually about 20% of the pancreas is resected.
The bottom part of the bile duct, the first portion of the duodenum, gall bladder, surrounding lymph nodes and occasionally a portion of the stomach are removed to ensure the removal of organs possible invaded by cancer cells.

The remaining portions of the pancreas, bile duct, duodenum and stomach are stitched together to preserve the continuity of the digestive tract. After ample time to recover and heal, the pancreas will produce digestive juices and enzymes, which will pass through the bile duct towards the duodenum to aid in food digestion and absorption.

What Happens After the Whipple Procedure

Chemotherapy and radiation therapy are usually considered after a Whipple procedure for pancreatic cancer. Even with the high accuracy of detailed imaging studies pre-operatively and the expertise of the oncologist, some cancer cells may evade detection. Supplement therapies will ensure that no cancer cells are missed.
A study has shown that at least an additional 10% benefit for long-term survival is achieved with adjuvant chemotherapy and radiation therapy.
second block:

Awareness of the Whipple procedure for patients with pancreatic cancer leads to understanding the available treatment options and eventually enables a patient to make an informed decision. Questions and second thoughts should be clarified so that the patient and their families and loved ones feel enlightened about the path they will be taking. No one should go through pancreatic cancer alone, and definitely, no one should go through a Whipple procedure without proper information and understanding.

The Different Stages of Pancreatic Cancer

Clinical findings, biopsy and imaging studies are combined to assign a stage to the cancer.

T for tumor size, N for node involvement, and M for metastasis comprise the TNM system, and eventually get summed up in a staging system.

• Stage 0 – Cancer found only in the lining of the pancreas
• Stage I – Cancer limited to the pancreas
  • Stage IA – Tumor size is 2 centimeters or less
  • Stage IB – Tumor size is more than 2 centimeters
• Stage II – Cancer has spread to nearby organs and tissues (duodenum, bile duct etc.)
• Stage IIA – Cancer has spread to nearby organs, but no lymph node involvement
• Stage IIB – Cancer has spread to nearby organs and lymph nodes
• Stage III – Cancer has spread to the major blood vessels near the pancreas, irrespective of node involvement
• Stage IV – Cancer has spread to stomach or distant organs

The higher the number, the more advanced the cancer is. However, this staging system can be difficult and sometime impossible to establish prior to surgery, because the exact location doesn’t always show up on a CT scan.

In addition, as if pancreatic cancer is not ominous enough, the TNM system can be difficult to understand and clasify.

Surgical Classification

A simpler staging system that facilitates understanding and provides a more practical standpoint is used by doctors. This system divides cancers into groups that are based on the possibility of being removed surgically.

• Resectable cancers are localized in the pancreas and the entire tumor can be removed.
• Locally advanced or unresectable tumors are yet to spread to distant organs but it cannot be completely removed, mostly because of surrounding blood vessels. For these cases, surgery can be done to relieve obstruction.
• Metastatic cancer has spread to distant organs. Surgery may still be done but the goal is to relieve symptoms of obstruction but not to cure the cancer.

If the cancer is at an early stage, surgery can be curative. For advanced stages of pancreatic cancer, surgery is considered to relieve symptoms. Other options such as radiation and chemotherapy are available as well.
Overall, the aggressiveness of treatment is determined by the stage of pancreatic cancer, overall strength and health of the patient and the judgment of the oncologist.

It is affected by different factors such as cancer stage, a patient’s overall health status and several other conditions that affect recovery.

So please remember that the numbers in this article are only averages and vary for each individual.

Whipple Procedure Prognosis: Increased 5 Year Survival Rate

Pancreatic cancer patients have a 5% 5-year survival rate. For patients who undergo a Whipple procedure, this rate increases up to 20%. That means the chances of living to 5 years after the diagnosis is increased from 5% to 20%.

For patients with cancer-free lymph nodes, the 5-year survival rate is at 40%. Survival rate is even better for patients with noncancerous tumors of the pancreas, the Whipple procedure prognosis is a long natural life.

Whipple Procedure Prognosis: Long Term Consequences

In a study to determine the quality of life of Whipple procedure survivors, many patients reported to be able to return to normal functions. However, some patients required alterations in diet, lifestyle or general living conditions.

When the remaining portion of the pancreas is not capable to produce enough enzymes for digestion of food, indigestion can occur, which results in abdominal discomfort or a “bloated” feeling. Breaking down three big meals to five to six small meals a day may lessen the load on the pancreas. In severe cases, medications to replace or supplement pancreatic enzymes are prescribed.

Immediately after the procedure, it is common for patients to lose weight. Around 7% of preoperative body weight is lost. After the adjustments on diet, weight stabilizes rapidly and patients maintain their new weight easily and do well.

Post Whipple Procedure Diet

After surgery, patients experience loss of appetite. For the first few weeks, food will taste bland, or worst have a bad taste. However, to meet the increased demands of the healing body, a balanced diet is necessary. The body requires more calories and protein than normal and at the same time the stomach can’t be overfilled and the pancreas can’t be burdened.

Plan meals into small and strategically scheduled portions for maximized energy and hydration for the day. Avoid gas-producing foods such as broccoli, cabbage and dried beans, at least for the first 2-4 weeks post-surgery. Wait for at least one month before resuming dairy products. Also go easy on “sweets” such as candies and cakes for up to three months after the Whipple procedure to avoid “dumping syndrome”, which manifests as lightheadedness and diarrhea.

The Whipple procedure can increase a patient’s life expectancy and change the quality of life. Adapting to a new body state will always be challenging, but the necessary extra efforts are a reasonable price to pay for a second chance at life. Just like everything else in life, the Whipple procedure prognosis gets better and success is more possible if carried out with hard work and dedication.

One of these factors is the surgeon’s level of expertise, but in the hands of highly trained and experienced surgeons, the chance of Whipple procedure complications is minimal.

Complication no.1: Pancreatic Fistula

One of the complications during Whipple Procedure is the development of pancreatic fistula. After the tumor is removed from the pancreas, the cut end has to be sutured back to the duodenum to create passageway for the pancreatic juices and enzymes into the digestive tract. In some cases, the created passageway does not heal very well, it becomes faulty, and pancreatic juices begin to leak.

This complication occurs in about 4% of Whipple procedures, but the leaking eventually heals on its own. Re-operation is usually unnecessary, a leakage catheter can be sufficient to drain the pancreatic juices.

Complication no.2: Pancreatitis

Another possible complication is inflammation of the pancreas. The incision or the remaining parts of the pancreas may be infected and inflamed. Although not to be taken lightly, this can usually be managed with anti-inflammatory and anti-pyretic drugs and antibiotics.

Complication no.3: Delayed Gastric Emptying

Another Whipple procedure complication is delayed gastric emptying, due to paralysis of the stomach. Standard surgery procedure is to give patients intravenous fluids and withhold oral feeding for the first five to six post-surgical days. This is done to give the bowels sufficient time to heal and recover.

After the rest period, patients are started on a clear liquid diet. They are slowly allowed to progress to a regular diet. By this time, the stomach is expected to contract and move food down to the intestines.
To assist in the patient’s nourishment, osterized food is given through a small feeding tube, which bypasses the stomach and ends in the intestines. In 4-6 weeks, almost all patients’ stomach functions return to normal.

In around 15% to 25% of Whipple procedure patients, the stomach remains paralyzed and requires more time to adapt and return to its normal function. A regular diet is not tolerated since gastric emptying is not at its normal rate.

The Whipple procedure is an answer to the many prayers of pancreatic cancer patients. However, it doesn’t come without risks and the need for a long recovery time. To minimize the possibilities of Whipple procedure complications, it is important to ascertain the medical center’s performance rates and the surgeon’s level of expertise.

No other common cancer had poorer prognosis and more than 15% of patients who underwent a Whipple procedure died during or after surgery.

Those times are long gone now.

Improvements to the Whipple Procedure Survival Rate

Scientific research and modern technology have improved surgical techniques, anesthesia and the quality of postoperative care. Procedure mortality has decreased greatly into a low single digit 5%.

Studies have shown that results are better at hospitals where Whipple procedures are done more often. Apparently, the health care quality and treatment outcomes are improved when complex surgeries and treatments are done in high volumes.

Another factor to consider for the Whipple procedure is the surgeon performing the procedure. The same commonsensical theory applies: the more procedures the surgeon performs, the lower the mortality rate and the higher the survival rates are. These are the reasons why patients are steered to specialized centers and surgeons with expertise in the field.

Impediments to Whipple Procedure Success

Even with the best surgeons and at the best hospitals, cancer cells may escape the pancreas and migrate to other parts of the body. These can remain undetected by diagnostic procedures before, during or immediately after the surgery, and eventually grow into new fatal cancers. This is why patients are advised to undergo treatment with radiation or chemotherapy.

At present, patients with untreated pancreatic cancer only have 6% 5-year survival rate. With the invention of modern equipment and refined techniques, the Whipple procedure survival rate increased the 5-year survival rate into 20%.

For patients whose cancer is limited to the head of the pancreas only, and where it is not spread to lymph nodes, have a higher 5-year survival rate at 40%.

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 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.