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Whipple Procedure
Aka: Whipple Procedure, Pylorus-Preserving Pancreaticoduodenostomy
- See Also
- Pancreatic Cancer
- Indications
- Resectable Pancreatic Cancer
- Procedure: Whipple Procedure
- Indicated in cancer of the head of Pancreas
- Structures removed
- Head and uncinate process of Pancreas
- Duodenum and first 15 cm of jejunum
- Gallbladder and common bile duct
- Anastomosis
- Stomach to jejunum
- Common hepatic duct to jejunum
- Pancreas to jejunum
- Procedure: Pylorus-Preserving Pancreaticoduodenostomy
- Indicated in cancer of the head of Pancreas
- Alternative to Whipple with same survival results
- Shorter procedure and less blood loss than Whipple
- Procedure: Distal Pancreatectomy
- Indicated in cancer of the head or tail of Pancreas
- Distal Pancreas and Spleen excised
- Adverse Effects
- Delayed Gastric Emptying
- Pancreatic fistula
- Leak from anastomosis
- Intra-abdominal abscess or Wound Infection
- Secondary endocrine deficiency
- Diabetes Mellitus
- Pancreatic exocrine insufficiency
- Perioperative bleeding
- Perioperative Mortality: Whipple Procedure
- Surgical teams performing 16 or more per year: 3.8%
- Surgical teams with <16 per year: 7.5% or lower
- Birkmeyer (2002) N Engl J Med 346:1128-37 [PubMed]
- Efficacy: All procedures
- Five year survival: 10-30% (15.2% on average)
- Pathology factors suggesting poorer prognosis
- Pathology with poor differentiation
- Resection margins positive for residual tumor
- Tumor spread to Lymph Nodes
- Tumor size >2 cm
- References
- Freelove (2006) Am Fam Physician 73(3):485-92 [PubMed]