Whipple procedure: 9 things to know

If you or someone you know has been diagnosed with pancreatic cancer, you may have heard of the Whipple procedure. This complex surgery is often used to treat pancreatic cancer, but it’s not an option for everyone.

To help patients learn more about the Whipple procedure and how it can impact quality of life, we spoke with pancreatic cancer surgeon Matthew H.G. Katz, M.D.

What is the Whipple procedure?

The Whipple procedure is a surgery that removes the head of the pancreas, the distal bile duct, the gallbladder, regional lymph nodes, and the duodenum — the first part of the small intestine that connects to the stomach.

For some patients, it may also include partial removal of the stomach, as well as nearby veins and/or arteries. The surgery is typically conducted through a single incision in the upper belly, although sometimes it may be conducted through several smaller incisions.

What types of cancer can the Whipple procedure treat?

About 70% of patients who get a Whipple procedure at MD Anderson have been diagnosed with pancreatic cancer. But it’s also used to treat:

• neuroendocrine tumors of the pancreas
• pancreatic cysts
• bile duct cancer
• duodenal cancer
• ampullary cancer
• cancers that originated elsewhere but spread to the pancreas

How do you determine whether someone is a good candidate for the Whipple procedure?

Typically, the Whipple procedure is a good option for patients whose cancer is confined to the pancreas or the small area adjacent to it, and who are in good enough health to reasonably anticipate that they will fully recover.

The Whipple procedure is generally not a good option for patients whose cancers have spread to other sites. Also, because it’s a complex operation, it’s not usually recommended if a patient is frail or not strong enough to make a full recovery.

What are the benefits of a Whipple procedure?

Generally, the goal of a Whipple procedure is to prolong a patient’s life, or even potentially cure them of cancer. For some patients, the goal might be to prevent or relieve symptoms such as pain or blockage of the bile duct or stomach.

Are there any alternatives to a Whipple procedure?

Yes. They may not do the exact same thing or yield the same results, but chemotherapy, radiation therapy or even a clinical trial are alternatives that might sometimes be preferable to a Whipple procedure.

As with any treatment, it’s important for patients to weigh the risks and benefits of a Whipple procedure and find the treatment option that meets their goals — whether that’s extending life, improving quality of life, or something else.

How long does it take to recover from a Whipple procedure?

Patients typically leave the hospital and go home within a week. But, for most people, it takes as long as 2 to 6 months to fully get back to a normal quality of life. Ultimately, patients should be able to do anything after surgery that they could do before. Some patients get back to running marathons after a Whipple procedure. But it really depends on the individual.

Some patients might be older and have an underlying disease that makes them a little sicker to start with. They also might be receiving other types of treatment — such as chemotherapy or radiation therapy — before or after the operation. All of these factors can impact recovery time.

If a Whipple procedure is done on the right patient for the right reason at the right time by the right surgeon, patients can expect a full return to the quality of life they had before cancer.

What are the potential side effects of a Whipple procedure?

Patients might need to eat smaller meals more frequently throughout the day, instead of three larger meals a day. But mostly, that’s just because it feels better. So, I look at that more as a lifestyle change, not necessarily a problem.

Some patients might need enzyme replacements and antacids. So, their medications may change. Patients may also see changes in their bowel habits, because we’re completely rerouting their gastrointestinal tract.

There could be long-term nutritional deficiencies as well. Fat-soluble vitamins like A, D, E and K might not be absorbed as efficiently. The duodenum is involved with absorbing minerals like calcium, too. When you take that out, it can cause a calcium deficiency over time.

The pancreas helps regulate glucose, so when you take out a piece of that, diabetes can sometimes occur. It’s a fairly uncommon side effect, but still one we look out for.

If a doctor recommends a Whipple procedure, what questions should patients ask before deciding whether to move forward?

There are several questions patients should ask to determine whether a Whipple procedure is the best option for them – and whether this is the best team to perform that surgery. These are the questions I recommend asking:

• What other treatment options are available?
• How will this benefit me, specifically?
• What will my recovery be like?
• How many Whipple procedures do you perform a year?
• What are your outcomes?
• What kind of team do you have in place to support me, not just during surgery, but afterward?
• How closely do you work with medical and radiation oncologists to develop patients’ treatment plans?

Why is it important to get your Whipple procedure done at a place like MD Anderson?

For one thing, at a high-volume cancer center like MD Anderson, we do more than 150 of these procedures a year, and most of our patients go on to make a full recovery.

But it’s also about your life afterward. We have an entire team of specialists to help patients manage any long-term issues that may occur after a Whipple procedure.

Nutritional deficiencies can occur after a Whipple procedure without proper management, so patients will need a dietitian. Some patients’ cancer could be linked to a genetic mutation, so they might need genetic counseling and testing. If complications occur, patients might need interventional gastrointestinal services.

Timing is also critical. To get the best results, patients need to balance the timing of the surgery with all the other treatments they might be receiving. It’s not enough to say that it’s possible to perform a Whipple procedure on a certain patient. You also have to do it at the right time. And our specialists routinely work together to give our patients the best results.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.