What is the Whipple procedure?
The Whipple procedure (also called a pancreaticoduodenectomy) is a surgery to remove a cancerous tumor from the head (right side) of your pancreas to stop it from spreading to other organs (metastasizing). Around 15% to 20% of people with pancreatic cancer are eligible for this surgery.
Where is the pancreas and what does it do?
Your pancreas is an important organ located in your abdomen. It’s shaped a bit like a fish. The widest part on the right is called the head. The middle section is called the neck or body, and the thin end is referred to as the tail. Your pancreas makes hormones, helps your body digest food and controls your sugar levels.
What is pancreatic cancer?
This type of cancer is caused by a growth (tumor) in your pancreas. The tumor usually grows in the head, neck or body of your pancreas. Few grow in the tail. Pancreatic cancer is primarily caused by smoking and most of those diagnosed are between the ages of 60 and 80 years.
Yearly in the U.S., about 57,000 people are diagnosed with pancreatic cancer and there are around 46,000 deaths. Only roughly 8.5% of people with this type of cancer live for another five years after their diagnosis.
When is a Whipple procedure done?
Pancreatic cancer is the most common reason that your surgeon performs a Whipple procedure. However, this operation may also be needed for:
- Pancreatic cysts.
- Small bowel cancer of the duodenum.
- Trauma to the pancreas or small intestine.
- Ampullary cancer.
- Bile duct cancer.
- Neuroendocrine tumors.
Is the Whipple procedure inpatient or outpatient?
The Whipple procedure is a major inpatient surgery. You’ll need to recover in the hospital for about a week.
Who performs the surgery?
A team of nurses, anesthesiologists and anesthetists assist your surgeon during the Whipple procedure.
What happens before the Whipple procedure?
If you have cancer, you may go through radiation or chemotherapy before you have the surgery.
Your surgeon will instruct you to stop taking certain medications in the days leading up to your surgery. You should also:
- Avoid food and drinks for eight hours before going to the hospital for your Whipple procedure, unless directed otherwise.
- Quit smoking — even if it’s just for two weeks before the Whipple procedure — to improve heart and lung health.
- Stop taking herbal supplements for one to two weeks before the surgery as directed by your healthcare provider.
- Not take Viagra® or other medications for erectile dysfunction at least 24 hours before a Whipple procedure.
- You should take certain (but not all) blood pressure medications with a sip of water as instructed by your provider.
Once at the hospital, your nurse will insert an intravenous line (IV) into your arm to inject fluids and medications you’ll need during the surgery. Additionally, an epidural catheter or spinal injection may be necessary. They block your nerves, helping decrease pain after surgery.
Where is the Whipple procedure performed?
The Whipple procedure is a complex operation with a high risk of major complications. It takes a lot of skill and experience to perform the surgery and manage any complications. To get the best outcome, you’ll want to have a very experienced surgeon and be in a hospital that performs at least 15-20 Whipple procedures each year.
Is the Whipple procedure an open or minimally invasive surgery?
An open surgery is one where the surgeon cuts one large opening. Minimally invasive (laparoscopic) surgery uses several smaller cuts (incisions). With a minimally invasive surgery, there’s usually less blood loss, fewer complications and a faster recovery time. Although a laparoscopic surgery is ideal for many indications, the Whipple procedure is usually an open surgery.
What are the steps of the Whipple procedure?
The Whipple procedure can be summed up in a few steps:
- A large incision will be made in your abdomen (or there will be a couple small ones if it’s a laparoscopic surgery).
- Your surgeon will remove the portion of your pancreas where the tumor is located along with the small bowel surrounding it (the duodenum), the lower section of the bile duct, the gall bladder and sometimes a part of your stomach.
- What’s left of your pancreas and bile duct get attached to your small intestine.
- The small intestine is then reattached to your stomach, ensuring that food can pass through the entire digestive tract.
How long does the Whipple procedure last?
The Whipple procedure is a complicated surgery that takes 4-12 hours.
Will I be asleep during the Whipple procedure?
Yes, you will be under general anesthesia for the Whipple procedure. This treatment makes you unconscious and insensitive to pain or other stimuli.
What should I expect after the Whipple procedure?
The Whipple procedure is a significant surgery. Recovery from the procedure will take some time.
You’ll have pain for a while after your Whipple procedure. During your hospital stay, your care team will manage your pain and watch for signs of infection or other complications. You’ll be on a clear, liquid diet for a few days until your healthcare providers feel that you’re ready to introduce solid foods. As soon as you feel up to it, you should start doing lung exercises (incentive spirometry) and moving about your room — just be sure to call a nurse or physical therapist for help getting up so you don’t fall.
Risks / Benefits
What are the advantages of the Whipple procedure?
A Whipple procedure increases your chances of long-term survival with pancreatic cancer. Unfortunately, very few people survive pancreatic cancer. Only about 8.5% of people with pancreatic cancer live for five years. If you have the Whipple procedure, your chances increase to 25%.
Does a Whipple procedure cure cancer of the pancreas?
A Whipple procedure is often the only hope for a cure from pancreatic cancer. However, cure rates depend on the location and stage of your tumor, as well as other individual factors. Ask your surgeon about whether they think a Whipple procedure will cure your pancreatic cancer.
What are the potential Whipple procedure complications?
As many as one-third of people who go through the Whipple procedure have complications, which include:
- Diabetes. This can be temporary or permanent.
- Problems with the fistulas.
- Bowel leakage.
- Leakage from the organs involved.
- Difficulty digesting some foods.
- Weight loss.
- Bowel changes.
Recovery and Outlook
What’s the survival rate for a Whipple procedure?
The survival rate for a Whipple procedure has improved a lot in the last few decades. Thirty years ago between 5% and 15% of people who went through the Whipple procedure died from complications. Now the mortality rate is about 1% to 3%.
How long will I be in the hospital?
Following surgery, you’ll recover in the hospital for about a week. During this hospital stay, your care team will monitor your pain levels and watch for complications.
How long does it take to recover from the Whipple procedure?
It’s a major surgery and recovery will take time. If there are no complications, you should be able to resume your normal activities in about 4-6 weeks.
What should my diet be after the Whipple procedure?
In the days following your Whipple procedure you’ll be on a clear, liquid diet. Your surgeon will decide when you’re ready to introduce solid foods. For a while, you will want to eat soft foods that are easy to digest. Talk to your healthcare provider about foods they recommend.
What medications will I need to take?
After a Whipple procedure, your surgeon will prescribe medications to help manage your pain. You may also be given medications to prevent clots in your legs.
When to Call the Doctor
When should I contact my surgeon?
Contact your surgical team if the following happens:
- Your stitches get loose, or they open.
- You develop a fever.
- Your incision looks red, feels warm, leaks pus or hurts worse.
- Your bowel movements are irregular.
When should I go to the emergency department?
Call emergency services or go to the nearest emergency department right away if you experience any of the following problems:
- High fever that doesn’t get better with medicine.
- Stroke symptoms — slurred speech, numbness, weakness, loss of balance and/or vision problems.
- Trouble breathing/shortness of breath, or if you stopped breathing for any reason.
- Severe chest pain or pressure.
- Any pain that is so severe that you can’t stand it.
- Injury to your head, neck or spine.
- Loss of consciousness (if you pass out/faint).
- Sudden weakness, especially if you can’t speak or move.
- Dizziness that doesn’t stop.
- Poisoning or an overdose.
- Severe allergic reaction.
- Severe burn, electric shock or lightning strike.
- Coughing or throwing up blood.
- Heavy bleeding.
A note from Cleveland Clinic
The Whipple procedure offers hope to people with pancreatic cancer. Removing the tumor can increase the quality and length of your life. Have your Whipple procedure performed by an experienced surgeon at a well-established hospital. It’s appropriate to ask your surgeon about how many times they’ve performed the procedure (try to find one who has done it 15 or more times).
Pancreatic cancer can feel like a devastating diagnosis. Fortunately, a Whipple procedure might extend your life expectancy.
What is the recovery from a Whipple? ›
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.What does the Whipple procedure treat? ›
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.How long are you in recovery room after Whipple surgery? ›
Recovery from the Whipple Procedure
This is a complex operation that will require hospitalization for one to two weeks with the first post-surgery night spent in the intensive care unit before being transferred to the surgical floor.
- Leaking from connections where the surgeon has joined organs (bile leak or gastric leak)
- Infection at the incision site or inside the abdomen.
- Problems with stomach emptying after eating.
- Difficulty digesting certain foods.
- Weight loss.
- Bowel habit changes.
Overall, the five-year survival rate after a Whipple procedure is about 20 to 25%.What foods should you avoid after Whipple surgery? ›
Avoid fried, greasy and fatty foods. These foods are hard to digest with an altered pancreas. Choose baked, broiled, or grilled foods instead. After a Whipple procedure, it is often recommended to limit fat intake to no more than 40-60 grams per day.How long does it take for your pancreas to heal after Whipple surgery? ›
Complete recovery from the Whipple procedure can take up to two months. But in rare cases, it can take up to six months to recover. Patients usually need to take a daily vitamin with iron and a daily medication to reduce stomach acid. Some patients temporarily have trouble regulating their blood sugar levels.Do you need chemo after a Whipple? ›
You should be offered chemotherapy after surgery to remove the cancer (such as the Whipple's procedure), to try to reduce the chances of the cancer coming back. There are three types of chemotherapy that may be used: FOLFIRINOX. gemcitabine with capecitabine (GemCap)What can you not do after Whipple surgery? ›
Take the pain medications whenever you need it and as instructed by your doctor. Do not do any heavy lifting or straining for at least 6 weeks after surgery. Do not lift anything over 10 pounds or 5 kg. Do not drive if you are taking pain medication because these medications can cause you be sleepy or drowsy.How long do you have pain after Whipple surgery? ›
It is normal to have some pain and discomfort for a few weeks after surgery. Straight after the operation, you may have painkillers through an epidural (a drip in your spine).
What is the best hospital to have the Whipple surgery? ›
Mayo Clinic surgeons are specially trained to provide you with the best care, and they perform over 450 Whipple procedures and related surgeries each year. Mayo Clinic in Rochester, Minnesota, and Mayo Clinic in Phoenix/Scottsdale, Arizona, are ranked among the Best Hospitals for cancer by U.S. News & World Report.Do you need insulin after a Whipple? ›
Your pancreas makes insulin and controls your blood sugar. Since part or all of your pancreas is removed during the Whipple procedure, there is a chance that you may develop diabetes. Patients who have diabetes before surgery will need to adjust their diabetes medicine after surgery.What are the best foods to eat after Whipple procedure? ›
To help with healing, eat foods high in protein, such as tender meats, poultry, fish, dairy products, eggs, peanut butter, and beans. Drink supplements such as Boost, Ensure, or Carnation Instant Breakfast. At first, you may have problems tolerating fatty foods.Why is the Whipple procedure so difficult? ›
Whipple procedures are complicated because they involve so many different organs, but that's not the only reason. “The pancreas is located in a very difficult spot, deep in the central part of the abdomen,” Reddy explained.Can you live a long life after Whipple surgery? ›
Conclusion: Pancreatoduodenectomy for adenocarcinoma in the head of pancreas can provide long-term survival in a subset of patients, particularly in the absence of lymph node metastasis. One of 8 patients can achieve 10-year survival with a potential for cure.Is the Whipple procedure worth it? ›
A Whipple procedure increases your chances of long-term survival with pancreatic cancer. Unfortunately, very few people survive pancreatic cancer. Only about 8.5% of people with pancreatic cancer live for five years. If you have the Whipple procedure, your chances increase to 25%.What can I do instead of a Whipple procedure? ›
You may have an operation that's similar to the Whipple's, but none of the stomach is removed. This is called a pylorus-preserving pancreatoduodenectomy (PPPD). As part of your pancreas is removed, your digestion may be affected. You may need pancreatic enzyme replacement therapy (PERT) to help you digest food.Can you eat rice after Whipple? ›
Avoid foods high in insoluble fiber, such as whole grains, as many find them hard to digest immediately after surgery. Until your system settles down, eat “white” foods, such as white rice, pasta, bread, and crackers.Is the Whipple the hardest surgery? ›
The Whipple procedure is one of the most complex operations in surgery. It takes 6 to 8 hours, or longer, to perform, and the risk of complications is high. In the mid-1970s, more than one in ten patients did not survive the surgery, and, not surprisingly, relatively few patients were referred for the surgery.Is the Whipple procedure major surgery? ›
The Whipple procedure (pancreaticoduodenectomy) is a major, complex operation. It has to be done by a specialised pancreatic or hepato-pancreato-biliary (HPB) surgeon. Learn more about what happens: During the procedure.
What causes death after Whipple surgery? ›
Pulmonary complications was the leading cause of death after Whipple's procedure 3(12.5%) (Table 2). These results were statistically significant with p-value of 0.004. carcinoma, mainly carcinoma of head of pancreas. The age range of patients studied was 33-75 years with the mean age being 61.