The Whipple procedure is a form of cancer treatment used to treat pancreatic cancer. It is also referred to as a pancreaticoduodenectomy. It is a highly complex procedure, which involves removal of the pancreas, as well as parts of the stomach and intestine and/or other components of the digestive track. According to the American Cancer Society (ACS), it is a risky operation which should be performed only by an experienced surgeon.
Pancreatic Cancer and the Whipple Procedure
The pancreas is located between the spine and the stomach, deep inside the abdomen. It is made up of a head, body and tail, with the head being wider than the body and the tail being the narrowest part. It is part of the digestive track, and produces hormones and other bodily chemicals, including insulin and glucagon, that help with the digestion of food. Most pancreatic cancers begin in the exocrine cells, which are the cells that produce hormones. Pancreatic cancer is often difficult to treat, because it is often not diagnosed until the cancer has spread to other digestive organs or elsewhere in the region.
Standard Whipple
The standard Whipple procedure involves removing the head of the pancreas, and depending on the extent of the spread of the cancer, also removing the body. Typically, a portion of the small intestine and stomach, the gallbladder, and bile duct are removed as well, if the cancer has spread there. The small intestine is then attached to the remaining part of the bile duct to allow bile to get to the liver. Lymph nodes are also removed as part of this procedure. The American Cancer Society cautions that this procedure is very dangerous, and that in some hospitals, more than 15 percent of patients die from complications related to the surgery. The ACS warns that Whipples should only be performed in cancer hospitals and/or by specialty surgeons, and even then the risk of mortality for complications is still 5 percent.
Radical Whipple
A radical Whipple is similar to a standard Whipple. Lymph node dissection and the removal of the pancreas and other organs is still performed. However, a radical Whipple attempts to preserve the area where the stomach empties into a part of the digestive track called the duodenum.
Classic Whipple
A classic Whipple is also similar to a standard Whipple, but it removes more of the stomach (up to 40 percent of the stomach). According to a study called Pancreaticoduodenectomy Versus Pylorus-Preserving Pancreaticoduodenectomy, it is not clear whether this surgery has a notably lower rate of recurrence versus other forms of Whipple surgeries which preserve more of the stomach.
Distal Pancreatectomy and Splenectomy
A Distal Pancreatectomy and Splenectomy involves removal of the tail of the pancreas, and part of the body of the pancreas, as well as removal of the spleen. Typically, this treatment is used only to treat islet cell tumors (tumors in the tail or body of the pancreas) and not tumors found in the exocrine pancreas. Thus, patients whose cancers have been discovered in the exocrine pancreas and/or patients whose tumors have already spread are typically not eligible for this type of whipple procedure.
Tags: digestive track, standard Whipple, American Cancer, American Cancer Society, bile duct, body pancreas, body tail