Whipple Procedure (Pancreaticoduodenectomy)

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

A majority of pancreatic cancers start in the head of the pancreas, and a Whipple procedure is the treatment commonly used to remove tumors found in this area. It is also called a pancreatoduodenectomy or pancreaticoduodenectomy.

In addition to removing the head of the pancreas, this complex surgical treatment may include removal (resection) of nearby organs, structures and lymph nodes.

At the end of the procedure, the surgeon carefully reconstructs the remaining structures by reconnecting them to ensure that digestive fluids (enzymes) produced by the pancreas reach the small intestine to break down protein, carbohydrates and fats from foods.

What Is a Whipple Procedure?

A Whipple procedure for pancreatic cancer is surgery that enables patients to keep part of their pancreas. This important organ produces hormones such as insulin, which transfers blood glucose (sugar) to cells where it is used for fuel.

A Whipple procedure may be performed in three ways, as listed below,

Open surgery: The surgeon makes a large cut in the abdomen to reach the pancreas.

Laparoscopic surgery: The surgeon uses small cuts called keyholes and inserts surgical tools, including an instrument for viewing the pancreas (laparoscope).

Robotic surgery: Laparoscopic instruments are attached to a robot, which the surgeon controls from a computer panel. This offers the possibility of making smaller, more accurate cuts.

Doctors may recommend a Whipple procedure if diagnostic tests reveal that the pancreatic cancer is resectable, or able to be completely removed. A patient’s doctor will schedule an imaging test such as a computed tomography (CT) scan to confirm the cancer’s exact location and stage (spread) before making a Whipple surgery recommendation. Often, a staging laparoscopy is also performed to confirm that the cancer is removable.

Whipple procedure steps include removing:

• The head and sometimes the body of the pancreas
• Nearby lymph nodes
• The gallbladder
• Part of the common bile duct
• The duodenum, which is the beginning section of the small intestine
• Sometimes a part of the stomach called the pylorus, which connects to the duodenum

Once these organs and structures have been removed, reconstruction begins, which involves the surgeon:

• Attaching the remaining pancreas and bile duct to the remaining small intestine
• Reattaching any disconnected pieces of the small intestine to one another
• Reattaching any remaining portion of the stomach to the small intestine (if part of the stomach has been removed)

The time it takes the surgical team to complete a pancreaticoduodenectomy ranges from about four to nine hours.

Recovery

During the initial phase of recovery after a Whipple procedure, patients receive pain medication through a vein using an intravenous (IV) line. Their vital signs and surgical site drainage are monitored day and night. After a few days, the drainage tube and IV are removed, and patients start receiving pain medication in pill form.

Blood clot medication and insulin may also be given during recovery, and patients undergoing a Whipple procedure should expect to start drinking clear liquids the day after surgery. Foods are reintroduced as the patient is able to tolerate them. Chewing gum is sometimes recommended to help get the digestive system working again after the operation.

The care team may encourage patients to get up and walk or move around right away to help avoid blood clot formation. Breathing exercises are also recommended to reduce the chances of developing a lung infection.

One of the most serious issues that may arise after Whipple surgery is a pancreatic duct system leak, known as a pancreatic fistula. Fistulas may lead to a variety of complications. The doctor monitors the patient to see if fistulas or other potential complications develop.

During the recovery phase, laboratory tests are conducted on sample tissues that were removed during the procedure to test them for cancer. This helps the doctor understand how far the cancer spread, ensure that it has all been removed and recommend any necessary follow-up treatments, such as chemotherapy or radiation therapy.

Patients are released from the hospital about six to 12 days after a Whipple procedure. Once at home, they typically resume normal activities in about six to eight weeks. Those undergoing minimally invasive surgery, such as laparoscopic surgery or robotic-assisted pancreaticoduodenectomy, may heal faster than those who have had open surgery.

Diet After Whipple Procedure

Proper nutrition after a Whipple procedure helps patients heal faster and reduce postsurgical complications related to food digestion. Doctors and nutritionists may recommend:

• Eating smaller meals more often, about five to six times per day
• Eating high-protein meals, including foods such as beans, poultry, eggs or high-protein drink supplements
• Avoiding foods and drinks that are high in simple sugars, including alcohol, pies, doughnuts and sugar-coated cereal
• Delaying any weight-loss goals until healed to ensure that enough nutrients are being digested
• Chewing food thoroughly and eating slowly
• Drinking most liquids about 30 minutes before or after a meal for the first few weeks after surgery, and limiting liquids to four to five ounces per meal
• Limiting high-fat foods and carbonated beverages
• Adding in lactose-free milk and other dairy products

Whipple Procedure Complications

Sometimes, patients who undergo a Whipple procedure do not produce enough insulin after part of their pancreas is removed. They may develop diabetes and need to take insulin.

Additional side effects and complications of the surgery may include:

• Infections
• Leaking of surgical connections made during reconstruction
• Bleeding
• Changing bathroom (bowel) habits, like diarrhea, bloating or gas
• Problems emptying their stomach after eating
• Weight loss
• Food moving too quickly from the stomach to the small intestine (gastric dumping), especially if part of the stomach was removed
• Food moving too slowly from the stomach to the small intestine (gastroparesis), especially for patients who develop diabetes

In addition, if enough of the pancreatic cells that produce digestive enzymes are damaged or removed, a person may have problems digesting food and may need to take supplements (pills) to replace these enzymes.

Whipple Procedure Survival Rate

Surgical resection (removal) of a tumor may be linked to longer survival for some people with pancreatic cancer. One study showed that among patients who underwent a Whipple procedure for pancreatic cancer, 22.5% were still alive five years after the surgery. Another study found that when the Whipple procedure was performed to treat adenocarcinoma in the head of the pancreas, about 12.5% were still alive 10 years after the surgery.

Pancreatic cancer survival rates depend on a variety of factors, including how advanced the cancer is, its location, the patient’s overall health and other facts. Speak with the care team to get a personalized prognosis.

The City of Hope pancreatic surgical team has years of combined experience treating patients diagnosed with pancreatic cancer, and performs over 100 Whipple procedures each year.