Unless you or a loved one has recently been diagnosed with pancreatic cancer, you’ve probably never heard of the Whipple. The word “Whipple” seems playful in nature, but it’s actually the name of a complicated surgery for pancreatic cancer.
The Whipple procedure, also called a pancreaticoduodenectomy, is named for the surgeon, Dr. Allen Whipple, who pioneered the technique in the mid-1940s. Today, it is considered the most effective treatment for pancreatic cancer but it’s not an option for everyone.
To better understand this complex procedure, Michael Choti, MD, a pancreatic-hepatobiliary surgeon, surgical oncologist and division chief of surgery at Banner MD Anderson Cancer Center at Banner Gateway Medical Center, offered answers to questions you may have about it.
What is the Whipple procedure?
The Whipple is a complex operation because it involves many different organs that are located deep in the central part of the abdomen (or belly).
Typically, this procedure is done to treat localized cancer in the head of the pancreas that hasn’t spread to other tissues or organs, such as adenocarcinoma and neuroendocrine pancreatic cancer. It is also done for other cancers in the area (like duodenum, ampulla and distal bile duct) and other areas of the digestive tract (or stomach). “Sometimes it involves removing precancerous, benign cysts or polyps or to fix a perforation or tear due to trauma to the pancreas, possibly due to an accident or injury,” Dr. Choti said.
The goal is to cure cancer or prolong life, or, in some cases, prevent cancer.
“The surgeon removes the head of the pancreas, an area of the small intestine known as the duodenum, the gallbladder, part of the bile duct and lymph nodes,” Dr. Choti said.
Sometimes, the procedure may include the partial removal of your stomach, though this is not a preference.
“Most often, if cancer hasn’t spread, we don’t need to remove much or any of the stomach,” Dr. Choti said.
After the removal of organs and surrounding tissue, the remaining organs are then reattached to restore gastrointestinal continuity. This involves reconnection of the remaining pancreas, bile duct, and stomach.
Who is a candidate for the Whipple?
Unfortunately, not everyone is a candidate for this surgery. Evaluation by a multidisciplinary, experienced team is important, along with careful imaging, and pathologic and molecular testing.
Early diagnosis is important, when possible. The Whipple is generally not a good option for those whose cancer has spread. Cancer symptoms may include jaundiced (or yellowed) skin and eyes, dark urine and weight loss. An otherwise unexplainable new onset of diabetes can also be an early warning sign of pancreatic cancer.
To determine if you’re eligible for this type of procedure, you should seek out a surgeon who performs a high volume of pancreatic surgeries (15 or more surgeries a year).
How is the Whipple performed?
The procedure can be performed using either an open method or a minimally invasive surgery. Open surgery is one where the surgeon cuts one opening in your upper abdomen, while minimally invasive surgery uses smaller cuts to reach your organs.
“Minimally invasive Whipple is usually performed with robot assistance,” Dr. Choti said. “Minimally invasive surgery has advantages over the open approach, mostly associated with fewer incisional complications.”
The type of surgery performed will depend on your surgeon’s approach and your particular situation. However, having an experienced surgeon at a high-volume center can lead to fewer risks and better results.
Will there be scars?
There will be one larger scar on your upper belly or several tiny scars depending on the technique that is used. Skilled surgeons will do their best to assure the best possible cosmetic result to minimize your Whipple surgery scar.
Scars can take at least a few months to heal and for the color to fade. Talk to your surgeon or health care provider about how you can improve the appearance of the scar or scars.
Is there anything I can do to prepare for the surgery?
The Whipple can put some stress on your body—both physically and mentally. For the best chance of recovery and healing post-surgery, talk to your surgeon about what you can do beforehand to ensure you are strong and healthy for surgery.
“Many highly skilled facilities will have ‘prehabilitation’ programs to help patients be psychologically, physically and nutritionally prepared for the surgery,” Dr. Choti said. “The better prepared you are for surgery, the better the outcome.”
How long does it take to recover from the Whipple procedure?
The surgery usually takes four to five hours and patients typically only spend about five days in the hospital to recover.
After you return home from the hospital, it can take a month or so before you’re fully functioning. There are occasional complications that can delay recovery, but most people do well and return to their usual activities. How long it takes you to recover will depend on your physical condition before surgery and the difficulty of your operation.
Be sure to contact your surgical team if you experience any of the following symptoms:
- Fever
- Worsening pain
- Redness or swelling around the scar
- Oozing liquid or drainage from the scar
- The scar is warm to the touch
Will I have to change my diet after the procedure?
“Many patients have a misunderstanding that the Whipple procedure will cause problems with eating and nutrition, meaning they can no longer eat normally and have normal activity or function,” Dr. Choti said. “This is not true.”
It can take some time for your digestive system to work normally again, but most often you won’t have to make major or permanent dietary changes. In some cases, you may have to take pancreatic enzymes to help digest food properly.
Talk to your surgical team about what to expect following surgery regarding your diet and what foods they recommend.
Takeaway
The Whipple procedure is a highly complex surgery that is the most common surgery to remove tumors in the pancreas.
It’s important to find a skilled surgeon and surgical facility that performs these operations often.
Here are some questions to ask to guide your conversation:
- What are my treatment options?
- Is the Whipple procedure a good fit for my situation?
- How many procedures do you perform a year and what are your outcomes?
- Do you have a prehabilitation program?
- What will recovery be like? What support do you offer post-surgery?
Is the Whipple procedure right for you?
Schedule an appointment with a specialist to discuss your options.
