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The Whipple procedure (also known as pancreatoduodenectomy) is the most common operation for pancreatic cancer. It's also used for patients with cancer of the small intestine (duodenum), bile duct cancer and chronic pancreatitis and non-cancerous tumors of the head of the pancreas.

The surgery involves the removal of the head of the pancreas, most of the duodenum (a part of the small intestine), the gallbladder, a portion of the bile duct and sometimes a portion of the stomach. A piece of the small intestine is then attached to the bile duct, pancreas and stomach to allow your digestive secretions to empty.

Whipple: A Highly Specialized Procedure

Whipple surgery is a complex surgery that requires great expertise on the part of the surgeon.

A study published in the annals of surgery suggests that institutions should perform a minimum of 10 Whipple procedures annually to maintain the level of expertise and skills required by this complex surgery.

At UVA, our surgeons perform more than 50 Whipple procedures per year — more than five times that benchmark.

Who Should Have Whipple Surgery?

The goal of Whipple surgery is to only operate on patients who may have removable tumors. Your doctor will use a number of tests and procedures to determine whether or not your tumor can be removed.

Benefits of Whipple Surgery

Whipple surgery is the only surgery that has the potential to cure pancreatic cancer.

How Whipple Surgery Works

Whipple surgery can take 6-10 hours. If you are very weak prior to surgery, your doctors may need to start you on a program to improve your nutritional status and strength.

You’ll be given a general anesthetic for the operation. In order to access the many organs, a large abdominal incision will be made. Your surgeon will remove the necessary organs, and then spend time reconstructing your digestive tract.

Your intestine needs time to recover and begin functioning again; you’ll have to stay in the hospital until this occurs, typically up to 6-7 days. If you have any complications after the procedure, your stay could be longer.

Possible Complications

About 30% of all patients who undergo pancreaticoduodenectomy experience complications after surgery, although these are usually minor complications, such as wound infections. The death rate after operation is quite low (2% or less). The possible complications include:

• Bleeding—Most patients don't require a blood transfusion.
• Delayed stomach emptying—About 15-20% of patients who have had pancreatectomy will experience this complication. This involves liquids and solids remaining in the stomach for an abnormally long period of time after eating or drinking. This usually can be treated with medications. In some cases, patients with this complication may need to be fed using alternative methods (such as through a tube directly into their intestines) until their stomach heals.
• Pancreatic anastomotic leak—This complication occurs when pancreatic juices leak into the abdomen. If this occurs, it usually can be managed with a small drain placed by our radiologists.
  

Effectiveness

Pancreatic cancer is a very difficult disease to treat. Even with potentially curative surgeries, the five-year survival rate is low; only about 20% of people who undergo resection (removal of tumor) are alive five years after diagnosis.