Whipple Procedure for Carcinoma of the Pancreas - Part 1

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is the ninth most common cancer in the United States, but due to symptoms – such as back pain, jaundice and unexplained weight loss – usually only presenting when the disease has already moved beyond the pancreas, it is highly lethal, representing the fourth most common cause of cancer death. As a result of widespread abdominal imaging, more early stage pancreatic cancers are being diagnosed, and these patients are candidates for a pancreaticoduodenectomy, more commonly known as the Whipple procedure. The Whipple procedure is used to treat four types of cancer – periampullary, cholangiocarcinoma, duodenal, and pancreatic ductal adenocarcinoma – but is most well known in the setting of PDAC. Although there are only a few basics steps to the procedure – removal of the pancreatic head, distal bile duct, duodenum and either distal gastrectomy or plyloric preservation. Next is the reconstruction with bringing up the stapled end of jejunum to the pancrease, then the hepatic duct, and lastly to the stomach. The multiple crucial anatomic structures in the same region, as well as the unforgiving nature of the structures involved in the operation itself, lead to high morbidity and necessitate complex postoperative care. Due to this, most Whipple procedures are performed at higher volume centers.