Overview

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.

The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that's confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.

The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer.

Related procedures

Depending on your situation, your doctor may talk with you about other pancreatic operations. Seek a second opinion from a specialized surgeon if needed. Options include:

  • Surgery for tumors or disorders in the body and tail of the pancreas. Surgery to remove the left side (body and tail) of the pancreas is called a distal pancreatectomy. With this procedure, your surgeon may also need to remove your spleen.
  • Surgery to remove the entire pancreas. This is called total pancreatectomy. You can live relatively normally without a pancreas but will need lifelong insulin and enzyme replacement.
  • Surgery for tumors affecting nearby blood vessels. Many people are not considered eligible for the Whipple procedure or other pancreatic surgeries if their tumors involve nearby blood vessels. At a very few medical centers in the United States, highly specialized and experienced surgeons will safely perform these operations in select patients. The procedures involve also removing and reconstructing parts of blood vessels.

Mayo Clinic's approach

May 24, 2017
References
  1. Delaney CP. Pancreaticoduodenectomy. In: Netter's Surgical Anatomy and Approaches. Philadelphia, Pa.: Saunders Elsevier; 2014. https://www.clinicalkey.com. Accessed Feb. 22, 2017.
  2. Townsend CM Jr, et al. Exocrine pancreas. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Feb. 22, 2017.
  3. Reber HA. Surgical resection of lesions of the head of the pancreas. http://www.uptodate.com/home. Accessed Feb. 22, 2017.
  4. Croome KP, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Oncologic advantages over open approaches? Annals of Surgery. 2014;260:633.
  5. Asbun HJ, et al. Laparoscopic vs open pancreaticoduodenectomy: Overall outcomes and severity of complications using the Accordion Severity Grading System. Journal of the American College of Surgeons. 2012;215:810.
  6. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Feb. 9, 2017.
  7. Truty MJ (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 22, 2017.
  8. Niederhuber JE, et al., eds. Carcinoma of the pancreas. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed June 3, 2016.
  9. AskMayoExpert. Pancreatic cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  10. Pancreatic SPOREs. National Cancer Institute. http://trp.cancer.gov/spores/pancreatic.htm. Accessed. June 10, 2016.
  11. Thiels CA, et al. Outcomes of pancreaticoduodenectomy for pancreatic neuroendocrine tumors: Are combined procedures justified? Journal of Gastrointestinal Surgery. 2016;20:891.
  12. Ivanics T, et al. Small cell carcinoma of the pancreas: A surgical disease. Pancreas. 2016;45:1461.
  13. Barbara Woodward Lips Patient Education Center. Surgery of the extrahepatic bile duct, duodenum, papilla, or pancreas. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  14. Bergquist JR, et al. Implications of CA19-9 elevation for survival, staging and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis. Journal of Surgical Oncology. 2016;114:475.
  15. Katz MH, et al. Preoperative modified FOLFIRINOX treatment followed by Capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for Clinical Trials in Oncology Trial A021101. JAMA Surgery. 2016;151:e161137. Accessed March 29, 2017.
  16. Shubert CR, et al. Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: An intention to treat analysis of the National Cancer Database. Surgery. 2016;160:1080.
  17. Bergquist JR, et al. Risk by indication for pancreaticoduodenectomy in patients 80 years and older: A study from the American College of Surgeons National Surgical Quality Improvement Program. HPB. 2016;18:900.