II. Indications

  1. Resectable Pancreatic Cancer

III. 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

IV. 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

V. Procedure: Distal Pancreatectomy

  1. Indicated in cancer of the head or tail of Pancreas
  2. Distal Pancreas and Spleen excised

VI. 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 346:1128-37 [PubMed]

VII. 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

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