The Whipple Procedure

John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
Please explain the Whipple operation and why resecting the head of the pancreas (pancreaticoduodenectomy) is often not technically feasible in pancreatic carcinoma patients.  
Thank you very much indeed.
K.A.


Answer
John Han-Chih Chang, MD and Kenneth Blank, MD, OncoLink Editorial Assistants, respond:

Dear K.A.,
Thank you for your interest and question.

The Whipple procedure is a surgical operation performed on patients with pancreatic or duodenal cancer. A pancreaticoduodenectomy is the long name for this surgery that Dr. Whipple initially described in 1935. It requires the removal of the more proximal aspect of the pancreas, which includes the head and occasionally part of the body of the pancreas. There needs to be at least 10 - 20% of pancreatic tissue remaining in order to have significant endocrine function (insulin production) or digestive enzyme production, or else these need to be supplemented medically. The distal aspect of the stomach is removed also along with the gallbladder and the first segment of small intestine (the duodenum). The remaining stomach is joined to the jejunum (second segment of small intestine) distal to the cut end, while the remaining pancreas is attached to the cut end (Roux-en-Y technique) of jejunum.

Surgeons usually will operate on patients with localized lesions without evidence of disease spread elsewhere. However, most pancreatic carcinomas are very aggressive. So that, by the time they are diagnosed, in most cases, the patient's disease extends beyond what a Whipple procedure would encompass.