Whipple Procedure

The Whipple procedure is a complex surgery to remove cancer located at the “head” of your pancreas. This is an important junction point in your digestive system, where several organs meet. Cancer in any of these organs can spread to the others. So, the Whipple procedure removes the head of your pancreas along with other parts the cancer might spread to. These include your:

• Duodenum (first part of your small intestine, which wraps around the head of your pancreas)
• Common bile duct (which feeds into the head of your pancreas)
• Gallbladder (which connects to your common bile duct at the other end)
• Surrounding lymph nodes (usually the first place cancer spreads)
• In some cases, your pylorus (bottom part of your stomach, which connects to your duodenum)

The term “pancreaticoduodenectomy” means removing part or all of your pancreas and duodenum. But surgeons understand that removing these parts also means removing other parts that are connected to them. This offers the best hope of rooting out cancer in this area. After removing all these parts, your surgeon will reconnect the remaining parts so that your digestive system can continue to function.

What does the Whipple procedure treat?

Surgeons (most recently, Whipple) developed the pancreaticoduodenectomy procedure to remove pancreatic cancer and other cancerous tumors near the head of your pancreas. These might include:

• Pancreatic adenocarcinoma
• Pancreatic neuroendocrine tumors
• Intraductal papillary mucinous neoplasms
• Duodenal cancer
• Ampullary cancer
• Bile duct cancer

Occasionally, your healthcare provider might recommend the Whipple procedure to treat another condition that affects the whole area. For example, chronic pancreatitis may also affect other organs.

Who is not a candidate for the Whipple procedure?

The Whipple procedure might not be appropriate for you if:

• You have cancer in other parts of your pancreas, like the “body” or “tail:” In this case, your surgeon might recommend other procedures.
• Your cancer has spread beyond the original site: In this case, surgery might not be the most effective cancer treatment.
• The tumor is in a difficult location to operate on: For example, if it’s invading important blood vessels, it might not be safe to remove it.
• You’re not in good physical condition for the surgery: Your healthcare team will want to be sure that you have the resources to recover.

What is a modified Whipple procedure?

The modified Whipple procedure (pylorus-sparing Whipple) leaves your stomach intact. This might be an option if your condition doesn’t appear to involve your stomach. Because it leaves your pylorus intact, the modified Whipple procedure is less likely to affect your stomach function afterward. Surgeons choose this option whenever possible.

What happens before the Whipple procedure?

Before scheduling your Whipple procedure, your healthcare team will:

• Ensure that your cancer is operable: Sometimes, they can use imaging tests to determine this, like a CT scan or MRI. In other cases, they might need to conduct a staging laparoscopy. This is a minor procedure in which they insert a tiny camera into your abdomen to examine your organs.
• Discuss other cancer treatments: In some cases, your provider might recommend that you have other cancer treatments, like chemotherapy or radiation therapy, before surgery. In other cases, they might recommend that you have these treatments after surgery (adjuvant therapy).
• Consult with you about the operation: If your provider feels the Whipple procedure is the next best step for you, they’ll sit down with you to discuss the risks and benefits of the procedure. They’ll ask for your informed consent. They’ll also advise you on how to prepare for surgery.
• Work to optimize your overall health: Your healthcare team will want you in the best possible condition for this operation. You might need medical nutrition therapy or treatment for another condition first. If the tumor is obstructing your bile duct, they might need to place a stent in it.

What happens during the Whipple procedure?

You’ll spend five to eight hours in surgery for the Whipple procedure. You’ll have general anesthesia, so you’ll sleep through it. Your anesthesiologist will also use additional pain-blocking techniques to keep you comfortable during surgery. These may include nerve blocks and/or pain killers through an IV line. Your surgical team will monitor your vital signs and other important health indicators continuously.

You may have:

• Laparoscopic surgery or robotic surgery: Laparoscopy and robotic surgery are minimally invasive surgery techniques that use a small camera (laparoscope) through a small cut (incision) to look at your organs. Your surgeon operates through other small incisions. This can make for an easier recovery, but it takes advanced skills.
• Open abdominal surgery: With traditional open surgery, your surgeon makes one long incision in your abdomen to expose your organs. This makes them easier to access. Because the Whipple procedure is so complicated, some surgeons might feel more confident using this method.

Whipple procedure steps

Your surgeon will:

1. Remove your gallbladder and the part of your bile duct that connects it to your pancreas
2. Remove the affected portion of your pancreas
3. Divide your small intestine and remove your duodenum
4. Remove the lower section of your stomach (if needed)
5. Remove nearby lymph nodes
6. Create a new connection (anastomosis) between your pancreatic duct and small intestine
7. Create a new connection between your remaining bile duct and small intestine
8. Create a new connection between your stomach and small intestine (gastrojejunostomy)
9. Preserve and send all the removed parts to a pathology lab to test them for cancer cells

What are the risks and benefits of the Whipple procedure?

If you’re eligible for the Whipple procedure, it’s your best chance of surviving the type of cancer you have. Only about 20% of people diagnosed with pancreatic cancer can treat it effectively with surgery. That’s because this type of cancer is hard to catch in the early stages. Surgery only works if the cancer hasn’t already spread (metastasized). But if you can remove it all, you may stop it from spreading.

But the Whipple procedure does have its own risks and side effects. Recovery can be long and complicated. Your digestive system may take months to adjust and may never be the same. Most complications are temporary and treatable. But some can be lasting and affect your quality of life. And even if you don’t have any complications, the procedure can’t guarantee that you’ll survive cancer.

Complications

Complications of the Whipple procedure can include:

• Anastomotic leaks: The Whipple procedure involves three new anastomoses — connections between your organs. Complications can occur if these surgical connections leak.
• Changes in digestion: After surgery, you may find you have difficulty digesting certain foods, either in the short term or long term. Some people also experience changes in bowel habits.
• Delayed gastric emptying: Damage to nerves in your stomach can cause it to hold onto food too long. This is often a temporary problem that goes away when you’re fully recovered.
• Visceral artery pseudoaneurysm: A hole in your visceral artery could allow blood to leak out, forming a pool with a weak wall around it. If the wall breaks, it could cause a hemorrhage.
• Endocrine/exocrine insufficiency: When much of your pancreas is removed, it might not be able to make enough enzymes or hormones. This can lead to exocrine insufficiency and/or diabetes.
• Biliary stricture: Scar tissue from surgery on your bile duct can cause it to narrow too much, creating a blockage. Your surgeon might have to reoperate to remove the scar tissue.

What happens after the Whipple procedure?

You’ll spend a week to two weeks recovering in the hospital after surgery. You’ll have pain relief as needed. You may need to be fed through a tube or through an IV while your digestive system heals. In the meantime, your healthcare team will run tests to try to determine if they removed all the cancer. Depending on what they find, they might suggest additional treatments after you’ve fully recovered.

How long is the recovery from the Whipple procedure?

Most people can return to their activities after about six weeks. But it may take several months before you feel fully recovered. You might feel very tired during this time. Many people find they can eventually return to eating normally. But others might need long-term changes. If you have continuing digestive difficulties, talk to your provider. It’s important to get adequate nutrition while you’re recovering.

What is the Whipple procedure’s survival rate?

Current survival rates related to the Whipple procedure range from 97% to 99%. Survival rates after the procedure depend on the type of cancer you have, the stage and other factors. Most people who have the Whipple procedure can increase their life expectancy to some degree. When cancer has spread to nearby lymph nodes or other areas, the five-year survival rate after surgery is between 20% and 25%.