Whipple Group Research Articles

Pylorus Preserving Pancreatoduodenectomy Versus Whipple Procedurefor Adenocarcinoma of The Head of The Pancreas

Thirty eight patients underwent pancreatoduodenectomy for histologically confirmed adenocarcinoma of the head of the pancreas. Twenty one underwent a pylorus preserving pancreatoduodenectomy and seventeen the classical Whipple procedure. We undertook this retrospective analysis to compare longterm survival following the two different surgical procedures. Patients in the two groups were comparable for preoperative laboratory data, age and pathological staging. Minor and major morbidity was not different between the two groups (33.3% and 35.2% respectively). In the pylorus preservation group a delayed resumption of full oral diet and a consequent prolonged hospital stay has been noted (;21.3 days vs 15.4 days, p<0.05). Mean survival was 21 months in the pylorus preservation group and 17 in the Whipple group. No statistical difference was observed between the two survival curves. According to these data the pylorus preserving pancreatoduodenectomy represents a reasonable option for adenocarcinoma of the head of the pancreas.

Personal reflections on the surgical treatment of portal hypertension.

Reports, early in this century, on the treatment of portal hypertension by surgical diversion of the portal blood flow about the liver were largely ignored because of the anticipated high mortality. Whipple, Blakemore and Lord in the early 1940's described a technique of performing a splenorenal or portacaval shunt with an epithelial lined vitallium tube. Blalock, whom I assisted, was one of the first outside of the Whipple Group to successfully perform such an operation. Although he used the vitallium tube technique in his first cases he soon became convinced that the results were better with a direct suture anastomosis. Venous shunts, which seemed such a logical way to treat portal hypertension, were widely and quickly adopted. Little attention was paid to the problem of portal encephalopathy which had been described in experimental animals years before by Pavlov. As some of the follow up studies on these shunted patients began to appear it was evident that this was a common and at times a severe problem. Some of the earliest doubts about the shunt operation were expressed by surgeons in Japan. The most successful methods developed to date for the treatment of portal hypertension provided a shunt for blood from the esophageal variceal region while at the same time preserving portal blood flow through the liver. Two of these methods have been the distal or selective splenorenal shunt proposed by Warren & Zeppa and the coronary caval shunt first described by Inokuchi. These methods, although somewhat more difficult technically than end to side portacaval shunts, reduce portal hypertension and preserve blood flow through the liver thereby lowering significantly the incidence of encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of the pancreas: diagnosis and treatment.

We made a retrospective analysis of the hospital record of 65 cases of carcinoma of the pancreas occurring over a 16-year period at Bayley Seton Hospital, Staten Island, New York. The male sex predominated; the average age was 62.5 years. About 72% of the tumors were located at the head of the pancreas. The patients were divided into four groups: (1) those treated by pancreatoduodenectomy (Whipple resection) (14 cases), (2) those treated by bypass operations (21 cases), (3) those managed by exploration for biopsy only (12 cases), and (4) those in whom the carcinoma of the pancreas was found only at autopsy (18 cases). The operative mortality in the Whipple group was 7%; in the bypass group, 14%; and in the exploratory biopsy group, 36%. The mean survival in the Whipple group was 27.2 months with one survival more than ten years; in the bypass group, 6.5 months; and in the biopsy group, 2.6 months. Autopsy studies showed a high rate of regional and distant node metastasis, as well as nonnodal metastasis to other organs. Most of the patients died of carcinomatosis. The operative technics and the surgical literature are discussed.

The Validity of the Whipple Group Test in the Fourth and Fifth Grades

Among the special classes in operation in the schools of Jack son are what are known as classes, wherein pupils ac complish two semesters' work in one semester. Candidates for these classes are selected in part by means of group intelligence tests. In the spring of 1921 it was felt desirable to supplement the National Intelligence Test, Scale A, with some other group test in order to make a more accurate selection of pupils for the speed classes of the following autumn. The Whipple Group Tests for Grammar Grades were originally designed for the specific purpose of selecting gifted pupils?a purpose which was also ours. The Group Tests for Grammar Grades, however, had primary reference to grades above the fifth. Their applicability in the fourth and fifth grades was experimentally investigated with results which will be reported in this paper.