The Whipple procedure is the most common surgical procedure for treating pancreatic cancer. Surgeons might also use it to treat other conditions, including chronic pancreatitis.
The Whipple procedure is a treatment option for about 15–20% of people with adenocarcinoma of the pancreas, who have tumors that a surgeon can remove. Adenocarcinoma is the most common cancer of the pancreas.
The procedure cures pancreatic cancer in some people. In others, it may improve the chances of long term survival.
In this article, we explain the Whipple procedure, including its effectiveness and what to expect. We also discuss how a person can manage their diet after surgery and their likely outlook.
The Whipple procedure takes its name from Allen Whipple, an American doctor who first performed the surgery in the 1930s. Some people refer to it as a pancreaticoduodenectomy instead.
During the procedure, a surgeon removes the following:
- the gallbladder
- a section of the upper part of the small intestine called the duodenum
- a portion of the stomach called the pylorus
- the lymph nodes near the pancreas
- the head of the pancreas
One variation of the procedure leaves the pylorus behind, keeping the stomach intact.
As the Whipple procedure involves the removal of portions of several organs, it takes 5–8 hours to perform.
According to the American Cancer Society, pancreatic cancer accounts for about 3% of all cancer diagnoses in the United States and 7% of all cancer-related deaths. In the pancreas, the disease progresses 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 who do not receive surgical treatment.
Surgeons carry out the Whipple procedure to prevent pancreatic cancer from spreading to other parts of the body. People with the following conditions may also undergo this procedure:
- a type of bile cancer called cholangiocarcinoma
- ampullary cancer
- duodenum cancer
- benign pancreatic tumors
Some doctors offer robotic or laparoscopic surgery. These options may reduce blood loss and lead to fewer complications, but they can take longer.
The nonprofit organization Pancreatica report that people have a 5 year survival rate of 21% following a Whipple procedure. They also maintain that receiving radiation and chemotherapy alongside the procedure can almost double its effectiveness.
However, the survival rate in Pancreatica is from 1995. A more recent review from BMC Surgery puts the survival rate at just under 12% for people with pancreatic cancer that has spread to other organs.
The Whipple procedure is complicated, and it carries a risk of death, especially if an inexperienced surgeon carries out the procedure or it takes place in a hospital that rarely performs this surgery.
The Medical University of South Carolina estimate that approximately 2% of people who undergo the Whipple procedure will die as a direct result of the surgery.
The American Cancer Society recommend that candidates for a Whipple procedure visit an experienced surgeon who carries out at least 15–20 Whipple procedures every year. The hospital should also be a facility in which they regularly take place.
The overwhelming majority of people survive the operation and live longer than they otherwise would have done. However, 30–40% of people experience at least one complication.
In the days immediately after the procedure, it is common to experience delayed gastric emptying, which is when the stomach takes longer than usual to empty its contents. This complication usually resolves in a week or two, but some people may need a feeding tube for a few weeks.
Immediately after surgery, some people develop infections or bleed excessively. These symptoms can become life threatening without treatment. 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 temporarily or permanently experience more severe symptoms because of the surgery. People who have normal blood sugar levels before the surgery are unlikely to develop diabetes after it.
- Pancreatic fistula: If the stitches on the pancreas do not heal fully, it is possible that the pancreatic enzymes, or “digestive juices,” may 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 for them to absorb nutrients from food. As a result, diarrhea and other gastrointestinal difficulties may occur.
- Delayed emptying of the stomach: People may have difficulty digesting or keeping foods down for a while. This difficulty may lead them to have malabsorption issues and lose weight.
Removing part of the pancreas reduces its production of enzymes, meaning that digestion becomes more difficult. As a result, people may need to adjust their diets on both a short and long term basis following surgery.
A person can usually return to consuming food by mouth after the care team removes the feeding tubes. They should begin by drinking clear liquids before gradually advancing to solid foods.
During recovery, people should eat between six and eight small meals and snacks per day, rather than three large meals.
They should also take care to avoid fried or greasy foods. Raw fruits and vegetables might also be more difficult to tolerate, so people should limit their consumption of these foods at first and increase their intake as their pancreas readjusts.
On a longer term basis, people should continue to moderate their intake of fried and greasy foods and to consume fats from healthful sources, such as olive oil, nuts, and avocado.
They should be able to increase their fruit and vegetable intake to 2.5 cups every day.
Sometimes, a doctor may advise taking supplementary pancreatic enzymes and acid reducing medications to help ease digestion.
Most people undergoing a Whipple procedure do not require any special preparation. The night before surgery, they may need to avoid consuming food and water to reduce the risk of asphyxiation while under anesthesia.
As the Whipple procedure demands significant surgical skill and experience, people should ask their doctors the following questions:
- How long have they been performing this procedure?
- How many Whipple procedures have they performed, and what were the outcomes?
- How many of their Whipple procedure patients have died, and what was the cause?
- What are the specific risks of the procedure?
- What are the chances of surgical success?
- What are the chances of a cure?
- What are the most likely complications?
- How many Whipple procedures have taken place 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.
They will experience stomach and bowel paralysis in the days following the surgery and will need a feeding tube. The care team will insert this tube directly into the intestine during surgery, and it will remain in place until the individual has regained function in the stomach.
People should avoid doing strenuous activities for at least 6 weeks. After this time, they can gradually work up to their previous activity level.
Signs of an infection, such as pain, oozing from a wound, or fever, can indicate a medical emergency. People should call a healthcare professional immediately if they notice any such signs.
A person’s outlook following the Whipple procedure will depend on the reason for the procedure and the severity of the cancer, if applicable.
Most people with pancreatic cancer will need chemotherapy and radiation. These treatments weaken the immune system, so people usually need to wait until they have made a full recovery from surgery before starting them.
People should expect a doctor to continue to monitor them after a Whipple procedure, but most are likely to have an improved life expectancy.
However, people with pancreatic cancer generally have a poor outlook. While the Whipple procedure can extend life expectancy or improve symptoms during palliative care, the 5 year relative survival rate is 34% before the cancer spreads to areas other than the pancreas.