pancreatic cancer It is the fourth most common cause of death from cancer, and the 5-year survival rate is only about 12% despite advances in medical care, chemotherapy, radiotherapy, and molecular biology to remove the tumor. Pancreaticoduodenectomy, also known as the whipple procedure or pancreaticoduodenectomy operation, is the surgical procedure of choice for resectable pancreatic cancer. Studies It increases the patient's life expectancy to 15% to reach 10 years.
The whipple procedure can take several hours, is a major and challenging procedure and requires significant surgical skill and experience as well as an advanced hospital and medical team. The area around the pancreas is complex and surgeons often encounter patients who have a different arrangement of the blood vessels and ducts around the pancreas.
What is a Whipple procedure?
The whipple procedure is the surgical procedure of choice for resectable pancreatic duct cancer. Because of the combined perfusion of the digestive organs, surgical removal of the head of the pancreas also necessitates removal of the duodenum, jejunum, gallbladder and sometimes part of the stomach.
Broadly there are two types of pancreaticoduodenectomy; The most comprehensive are "classic Whipple (CW)" and "pyloric-sparing pancreaticoduodenectomy (PSD)".
After the Whipple procedure, the surgeon reconnects the remaining organs to allow you to digest food normally after the Whipple procedure.
Indications for the Whipple procedure on the pancreas
The whipple procedure is often performed as a surgical treatment for head cancer of the pancreas, carcinoma of the bile ducts, or cancer of the duodenum. Other indications include treatment of:
- Pancreas cancer
- pancreatic cysts
- pancreatic tumors
- chronic pancreatitis
- ampoule cancer
- bile duct cancer
- Neuroendocrine tumors
- small intestine cancer
- Trauma to the pancreas or small intestine
- Tumors or other disorders involving the pancreas, duodenum, or bile ducts
The goal of the Whipple procedure for pancreatic cancer is to remove the tumour and prevent it from growing and spreading to other organs. This is the only treatment that can lead to long-term survival and the most important treatment for most of these tumors.
Who are the candidates for Whipple surgery?
Only about 20% of pancreatic cancer patients are eligible for the Whipple procedure and other surgeries for the tumor. These are usually patients whose tumors are confined to the head of the pancreas and have not spread to any nearby major blood vessels, liver, lungs, or abdominal cavity. Extensive testing is usually required to identify potential candidates for a Whipple procedure.
Some patients may be eligible for the minimally invasive (laparoscopic) whipple procedure, which is performed through several small incisions rather than one large incision. Compared to the classic procedure, the laparoscopic whipple procedure may result in less blood loss, shorter hospital stay, faster recovery, and fewer complications.
Contraindications to the Whipple procedure
The most important absolute contraindications for this procedure are tumors that have spread in the abdominal cavity or to other distant organs such as the liver. Surgeons investigate the peritoneum and liver before starting the excision to detect the presence of metastases to them.
Surgeons may perform a separate procedure prior to Whipple surgery called diagnostic laparoscopy, which involves inserting a small camera through a small incision in the abdominal wall and studying the position and extent of the tumor, which may avoid major surgery.
Other contraindications for the Whipple procedure are tumor infiltration from the pancreas into major blood vessels such as the celiac artery, superior mesenteric artery, and inferior vena cava.
An overview of the Whipple procedure in Turkey
The surgery may take four to 12 hours, depending on the method used and the complexity of the operation. Whipple surgery is performed using general anesthesia, so you will be asleep and unaware during the procedure.
The surgeon makes an incision in your abdomen to access your internal organs. The location and size of the incision varies depending on your surgeon's approach and your situation.
Whipple surgery can be performed in different ways:
- Open surgery: The surgeon makes an incision in your abdomen in order to access your pancreas. This is the most common and most studied approach.
- Endoscopic Surgery: During laparoscopic surgery, the surgeon makes several small incisions in your abdomen and inserts special tools, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical instruments in the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.
- Robotic surgery: Robotic surgery is a type of minimally invasive surgery in which surgical instruments are attached to a mechanical device (a robot). The surgeon sits at a nearby console and uses hand controls to guide the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective.
Complications after the whipple procedure
Complications Immediately after the Whipple procedure, serious complications can affect many patients. The most common of these complications is the development of faulty ducts (fistulas) and leakage from the site of reconnection of the intestine (bile leakage and intra-abdominal pancreatic leakage). Surgeons place a surgical detonator near the anastomosis site to detect leakage as soon as it occurs.
Other potential surgical complications include:
- Trouble emptying the stomach after meals
Other complications after a Whipple procedure to resection of a pancreatic head tumor include:
- Weight loss: Most patients expect to lose weight after surgery (Whipple procedure).
- Diabetes: This condition can occur if too many insulin-producing cells are removed from the pancreas. However, patients who had normal blood sugar before surgery are unlikely to develop diabetes, and those who developed diabetes before the Whipple procedure are more likely to improve.
Extensive research shows that operations lead to fewer complications when performed by highly experienced pancreatic duodenal head surgeons at centers that perform many of these operations.
Recovery after the Whipple procedure
Patients after a Whipple pancreas procedure usually stay in the hospital for a week before returning home. Because recovery can be slow and painful, they usually need to take prescription or over-the-counter pain relievers.
At first, patients can eat only small amounts of easily digestible foods. They may need to take pancreatic enzymes — either in the short or long term — to help with digestion. Diarrhea is a common problem during the first two to three months that it usually takes for a rearranged gut to fully recover.
Warning after Whipple procedure for pancreatic head cancer
In general, the five-year survival rate after a Whipplewhiple procedure (resection of the head of the pancreas and duodenum) is about 20 to 25%. Even if the operation is successful in removing the visible tumor, it is possible that some cancer cells have already spread to other places in the body, where they can form new tumors and eventually cause death despite the removal of the primary tumor.
The five-year survival rate is higher in node-negative patients (the cancer has not spread to nearby lymph nodes) than in node-positive patients. Regardless of the condition of the node, most patients receive chemotherapy, radiation, or both after the Whipple procedure.
However, cancer specialists differ in opinions about the best combination and best drugs to use, recent trials have shown improved results with chemotherapy before Whipple, and with different chemotherapy regimens before and after resection.
Is there a custom diet recommended for people who have had the Whipple procedure for pancreatic head cancer?
Each surgery is different because each patient's disease status (eg, tumor location and tumor size) varies.
General diet recommendations after a Whipple procedure include:
- Eat 5-6 small frequent meals during the day to ensure adequate nutrition.
- Choose foods rich in protein and calories to help you recover and maintain weight.
- Avoid taking large amounts of fluids with meals, as this may affect the amount of food you can eat. It's okay to take a small sip with meals.
- If you experience gas, bloating, and/or diarrhea, pancreatic enzymes may be needed to help metabolize your food after you have had pancreatic whipple head resection surgery.
A low-fat diet does not always solve problems as it can actually be difficult to eat enough to maintain weight after a Whipple procedure. With pancreatic head resection, pancreatic enzymes may be needed to help absorb fats, carbohydrates, and protein.
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