Liver, Pancreas and Bile Duct Cancer Program

Whipple Procedure (Pancreaticoduodenectomy)

The following is a brief contribution from Douglas B. Evans, MD, Medical College of Wisconsin surgeon. Dr. Evans came to Froedtert & The Medical College of Wisconsin in January 2009 from the University of Texas MD Anderson Cancer Center, where he and his group defined how to manage patients with localized pancreatic cancer. Additional information can be found in manuscripts on this site.

Patients can be referred to Dr. Evans by talking directly with Gail Laschen in the Clinical Cancer Center at 414-805-6849.

The standard surgical treatment for cancer of the pancreatic head remains the pancreaticoduodenectomy, first described by Dr. A.O. Whipple in 1935. The world experience by 1941 totaled 41 cases. The original technique did not include reanastomosis of the pancreatic remnant to the small bowel, and the high complication rate in the early years was largely due to pancreatic fistula from the oversewn pancreatic remnant.

Illustrations

This article on the Whipple procedure is accompanied by a full set of images and illustrations in a PDF document that describes the operation in detail. Many of these illustrations have appeared in lectures that Dr. Evans has given on the topic of pancreatic surgery for cancer.

Therefore, Whipple modified his reconstruction in 1941 to include a pancreaticojejunostomy. In 1946, Waugh and Clagett modified the operation to its current form. The goals of surgical therapy outlined by Waugh and Clagett have not changed in the past 50 years: (1) there should be reasonable opportunity for cure, (2) the risk of death should not outweigh the prospects for cure, and (3) the patient should be left in as normal a condition as possible.

Recent advances in surgical technique, anesthesia and hospital care have resulted in a 30-day in-hospital mortality rate of less than 1 percent for pancreaticoduodenectomies performed at major referral centers by experienced surgeons. Achieving such a low surgery-related mortality rate appears to be a function of the level of experience of the individual surgeon and institution. Patient selection, preoperative medical evaluation, surgical technique, and postoperative care are all critically important in minimizing patient morbidity and mortality and optimizing long-term oncologic outcome. A reasonable level of experience with major pancreatic resection is thus necessary to achieve good results.

Incredible Story

Chicago resident Sally Levin benefited from a combined treatment approach that included chemotherapy, radiation and surgery. Read her incredible story.

Author: Douglas Evans, MD

Date: Aug. 1, 2009