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Whipple ProcedureAka: Pylorus-Preserving Pancreaticoduodenostomy

See Also
1. Pancreatic Cancer
Indications
1. Resectable Pancreatic Cancer
Procedure: Whipple Procedure
1. Indicated in cancer of the head of pancreas
2. Structures removed
  1. Head and uncinate process of pancreas
  2. Duodenum and first 15 cm of jejunum
  3. Gallbladder and common bile duct
3. Anastomosis
  1. Stomach to jejunum
  2. Common hepatic duct to jejunum
  3. Pancreas to jejunum
Procedure: Pylorus-Preserving Pancreaticoduodenostomy
1. Indicated in cancer of the head of pancreas
  1. Alternative to Whipple with same survival results
2. Shorter procedure and less blood loss than Whipple
Procedure: Distal Pancreatectomy
1. Indicated in cancer of the head or tail of pancreas
2. Distal pancreas and spleen excised
Adverse Effects
1. Delayed gastric emptying
2. Pancreatic fistula
3. Leak from anastomosis
4. Intra-abdominal abscess or wound infection
5. Secondary endocrine deficiency
  1. Diabetes Mellitus
  2. Pancreatic exocrine insufficiency
6. Perioperative bleeding
7. Perioperative Mortality: Whipple Procedure
  1. Surgical teams performing 16 or more per year: 3.8%
  2. Surgical teams with <16 per year: 7.5% or lower
  3. Birkmeyer (2002) N Engl J Med 346:1128
Efficacy: All procedures
1. Five year survival: 10-30% (15.2% on average)
2. Pathology factors suggesting poorer prognosis
  1. Pathology with poor differentiation
  2. Resection margins positive for residual tumor
  3. Tumor spread to lymph nodes
  4. Tumor size >2 cm
References
1. Freelove (2006) Am Fam Physician 73(3):485

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.