Whipple procedure: What you need to know
This complicated procedure involves removal of the gallbladder, lymph nodes near the pancreas, and portions of the pancreas, small intestine, and stomach.
In some recipients, the procedure cures their cancer. In others, it may improve long-term survival.
What is it?
The Whipple procedure is named after Allen Whipple, an American doctor who first performed the surgery in the 1930s.
During the procedure, a surgeon removes the gallbladder, a portion of the duodenum (the upper part of the small intestine), a portion of the stomach called the pylorus, lymph nodes near the pancreas, and the head of the pancreas.
One variation of the procedure leaves the pylorus behind, keeping the stomach intact.
The Whipple procedure removes portions of so many organs that it takes between 5 and 8 hours to perform.
According to the American Cancer Society, pancreatic cancer accounts for about 3 percent of all cancer diagnoses but 7 percent of cancer-related deaths. This is because the disease grows quickly and tends to spread before producing any symptoms.
However, people with pancreatic cancer who undergo surgery tend to have a better long-term survival rate than people not treated with surgery.
The Whipple procedure is carried out to prevent pancreatic cancer from spreading to other parts of the body. Surgeons also perform the Whipple procedure for:
- a type of bile cancer called cholangiocarcinoma
- ampulla cancer
- duodenum cancer
- benign pancreatic tumors
Some doctors offer robotic or laparoscopic surgery options. These options may reduce blood loss and have fewer complications, but they can also take longer.
Only between 15 and 20 percent percent of people with pancreatic cancer are candidates for a Whipple procedure.
The Whipple procedure can lead to 5-year survival rates of around 20 percent in people with pancreatic cancer. Individuals whose cancer has not spread to the lymph nodes have 5-year survival rates of around 40 percent. The procedure can cure patients with benign or low-grade tumors.
Most people who undergo a Whipple procedure will also need chemotherapy and radiation. These treatments can improve survival rates by up to 10 percent.
People who undergo the Whipple procedure may need to make some lifestyle changes and can experience side effects after the surgery. For most people, these changes are tolerable.
A Johns Hopkins survey found that 188 people who had the Whipple procedure rated their quality of life at 79 out of 100, compared to a rating of 83 among healthy people.
In the 1960s and 1970s, the Whipple procedure carried a high risk, with mortality rates as high as 25 percent. This death rate was due to the complexity of the surgery, as well as the poor health of the recipients. Now, the procedure is much safer, with mortality rates of around 2-3 percent.
When performed by inexperienced surgeons or in hospitals that rarely perform the Whipple procedure, however, death rates are higher. The American Cancer Society recommend having the surgery done by an experienced surgeon in a hospital that carries out at least 15-20 Whipple procedures every year.
The overwhelming majority of people survive the operation and live longer than they otherwise would have done. However, between 30 and 40 percent of people experience at least one complication.
In the days immediately following the procedure, it is common to experience delayed gastric emptying. This occurs when the stomach takes longer than normal to empty its contents. Delayed gastric emptying usually resolves in a week or two, but some people may require a feeding tube for a few weeks.
Immediately following surgery, some people develop infections or excessive bleeding. These symptoms can become life-threatening if left untreated. With prompt intervention, however, they are usually treatable.
Other complications of surgery can include:
- Diabetes: Removing part of the pancreas reduces insulin production. People who already have diabetes may experience more severe symptoms after surgery.
- Dietary changes: Most people do not need to change their diet after the procedure. Lower insulin production, however, may mean that some people have to reduce their sugar intake.
- Pancreatic fistula: If the stitches on the pancreas do not heal properly, it is possible for the pancreatic juice to leak. While leakage typically stops on its own, some people may need further surgery.
- Nutritional malabsorption: Decreased production of pancreatic enzymes in some people can make it difficult to absorb nutrients from food. This can lead to diarrhea and other gastrointestinal difficulties.
- Weight loss: People may lose 5-10 percent of their total body weight due to problems eating in the weeks following surgery.
Most people undergoing a Whipple procedure do not require any special preparations. The night before surgery, they may be advised to avoid food and water to reduce the risk of asphyxiation while under anesthesia.
Because the Whipple procedure demands significant surgical skill and experience, people should ask their doctors the following questions:
- How long have they performed these procedures?
- How many Whipple procedures have they performed, and what was the outcome?
- How many of their Whipple procedure patients have died? What was the cause?
- What are the specific risk factors?
- What are the chances of surgical success?
- What are the chances of being fully cured?
- What are the most likely complications?
- How many Whipple procedures are done in this hospital each year?
- What is the length of the hospital stay?
Most people will stay in the hospital for 1-2 weeks following the Whipple procedure.
People will experience stomach and bowel paralysis in the days following the surgery and will need a feeding tube. The tube is inserted directly into the intestine during surgery and will remain in place until the individual has regained stomach function.
During recovery, people should eat small, more frequent meals rather than three large meals per day. Avoiding fatty foods, taking a nutritional supplement, and drinking plenty of fluids can support the healing process.
People should avoid strenuous activities for at least 6 weeks. Afterward, they can gradually work up to their previous activity level.
Signs of an infection, such as pain, oozing from a wound, or a fever, can signal a medical emergency. People should call a healthcare professional immediately.
The outlook depends on the reason for the procedure and the severity of any cancers involved.
Most people with pancreatic cancer will need chemotherapy and radiation. Since these treatments weaken the immune system, people usually need to wait until they have made a full recovery from surgery before starting them.
People should continue to be monitored by a doctor, but most can expect an improved life expectancy after a Whipple procedure.