Are You a Good Candidate for the Whipple Procedure?

Was this helpful?
32
Doctor and patient
Getty

Pancreatic cancer remains a difficult-to-treat condition, but surgery sometimes can remove pancreatic tumors before they spread to other areas of the body. The most common surgery for pancreatic cancer is the Whipple procedure, named for the surgeon who first described and performed it.

Medically termed “pancreaticoduodenectomy,” Whipple surgery removes the gallbladder, along with parts of the pancreas, small intestine, and sometimes part of the stomach. Not everyone qualifies for the Whipple procedure for pancreatic cancer. The surgery is complex, with a difficult recovery and uncertain prognosis.

Who Is a Candidate for the Whipple Procedure?

Although the Whipple procedure is most closely associated with pancreatic cancer, the surgery may be performed to treat a host of other conditions, including:

  • Ampullary cancer (a tumor that arises at the junction of the bile duct and pancreatic duct)
  • Bile duct cancer (tumors in the common bile duct)
  • Cancer of the pancreas
  • Cancers of the small intestine
  • Cysts within the pancreas
  • Neuroendocrine cancers (tumors in cells that possess both neurological and endocrine traits)
  • Trauma to the small intestine, pancreas, or surrounding structures

For pancreatic cancer, specifically, the Whipple procedure is considered only for tumors that have not metastasized (spread) to other structures. An individual with tumors of the pancreatic head that have not spread are a typical candidate for the Whipple procedure.

Whipple Procedure Complications and Risks

Pancreaticoduodenectomy can be performed in several different ways. The “classic” Whipple procedure removes the gallbladder, head of the pancreas, bile duct, duodenum (first section of the small intestine), and sometimes part of the stomach. Alternative approaches may remove the middle section and tail of the pancreas, the spleen, and adjacent lymph nodes. One surgical approach preserves the pylorus—the opening between the stomach and the small intestine.

All of these surgeries are complex and carry a risk of complications that include:

  • Bleeding
  • Diabetes (since the pancreas produces insulin)
  • Infection
  • Internal leakage of stomach contents or other fluids from the surgical sites into the abdomen
  • Issues with stomach emptying
  • Weight loss

It’s also possible that pre-surgical imaging studies and lab tests will not show that a pancreatic or other tumor has metastasized. A surgeon may discover this only after opening the abdomen and, subsequently, the surgeon will be unable to perform the surgery.

Whipple Procedure Prognosis

As with any treatment, prognosis refers only to statistical models, not to individual human beings. Research into life expectancy after undergoing a Whipple procedure for cancer finds significant statistical variance, depending on factors like the type of tumor removed, differentiation of the tumor, sex of the patient, experience level of the surgeon, specific type of procedure performed, and so on.

One retrospective study concluded that pancreaticoduodenectomy as a treatment for a tumor in the pancreatic head resulted in a 5-year survival rate of about 18% and a 10-year survival rate of 13%. Given these relatively low survival rates, coupled with a somewhat arduous recovery period after the surgery, some people with pancreatic cancer wonder if the Whipple procedure is worth it. Every person must make this decision for themselves, considering their personal values, life situation, and other unique factors. There is no right or wrong answer.

Pancreatic cancer remains difficult to treat, with a poor long-term prognosis. If you decide to pursue a Whipple procedure for cancer or another condition, be sure to find a surgeon who specializes in this procedure. Look for a doctor who performs more than a dozen Whipple procedures a year. Working with an experienced surgeon can improve your prognosis after a Whipple procedure and allow you to maximize your quality of life afterwards.

Was this helpful?
32
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 May 13
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Surgery for Pancreatic Cancer. U.S. National Library of Medicine, MedlinePlus. https://medlineplus.gov/ency/article/007649.htm
  2. The Whipple Procedure. Johns Hopkins Medicine. http://pathology.jhu.edu/pancreas/whipplePop.php
  3. Whipple Procedure (pancreaticoduodenectomy). Pancreatic Cancer Action Network. https://www.pancan.org/facing-pancreatic-cancer/treatment/treatment-types/surgery/whipple-procedure-pancreaticoduodenectomy/
  4. Whipple Procedure. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/whipple-procedure/about/pac-20385054
  5. Pylorus-preserving Pancreaticoduodenectomy. UpToDate.com. https://www.uptodate.com/contents/pylorus-preserving-pancreaticoduodenectomy
  6. Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247(3):456–462. https://pubmed.ncbi.nlm.nih.gov/18376190-long-term-survival-after-pancreatoduodenectomy-for-pancreatic-adenocarcinoma-is-cure-possible/
  7. Chen S-C, Shyr Y-M, Wang S-E. Longterm survival after pancreaticoduodenectomy for periampullary adenocarcinomas. HPB (Oxford). 2013 Dec; 15(12): 951–957. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843613/