It can be scary, overwhelming, and shocking if you or a loved one has been diagnosed with pancreatic cancer. Especially considering most people didn’t have many symptoms, if any at all, before their cancer diagnosis. This is because pancreatic cancer symptoms typically don’t appear until it is already in its late stages or when it has already spread.
One of the first questions people often ask is if pancreatic cancer will kill you. Unfortunately, pancreatic cancer has the highest mortality rate of all major cancers. It is currently the 3rd leading cause of cancer-related death in the United States and is expected to become the 2nd by 2030.
Late diagnosis is likely one reason pancreatic cancer is on the rise. That said, some treatments and surgeries increase your chances of survival and can improve your quality of life.
The most common surgery for pancreatic cancer is called a Whipple procedure. Also known as a Kausch-Whipple operation or pancreaticoduodenectomy.
In this article, it is our hope to provide pancreas cancer awareness and help you better understand what the Whipple procedure is, why it might be the best path you should take, potential complications from the surgery and what both during and after the surgery expect should your surgeon suggest the Whipple procedure is the best treatment path for you or a family member with cancer.
TYPES OF PANCREATIC CANCER
Pancreatic cancer usually begins in the tissue of the pancreas, an organ located behind your stomach that helps you digest food.
Over 90% of all pancreatic tumors are exocrine tumors. The most common type of pancreatic cancer is pancreatic ductal adenocarcinoma. This is when cancer begins in the cells that line the ducts of the pancreas. Most commonly (approximately 75%), this occurs in the head of the pancreas, the widest part of the pancreas found on the right side of the abdomen.
Much fewer cases occur in the tail of the pancreas, the thin tip of the pancreas on the left side of the abdomen.
PANCREAS SURGERY OPTIONS AND WHY A WHIPPLE PROCEDURE MIGHT BE THE BEST TREATMENT OPTION
Pancreatic cancer treatment options are chosen based on where the cancer is in the pancreas, its extent, and if it has spread.
Your doctor might suggest surgery, chemotherapy, radiation, or a combination of several treatments.
When it comes to surgery for pancreatic cancer, there are several. The best surgery for you will depend on where your cancer is located.
You might have a distal pancreatectomy for cancer in the body or tail of the pancreas. This is a surgery to remove the body and tail of your pancreas. Very rarely, your surgeon might plan to remove the whole pancreas. This is called a total pancreatectomy.
For cancer in the head of the pancreas, you will likely be encouraged to have a type of surgery called pylorus-preserving pancreaticoduodenectomy (PPPD) or the Whipple procedure. The Whipple procedure is the most common pancreatic cancer surgery and the one we will be discussing in this article.
WHAT IS A WHIPPLE PROCEDURE
A Whipple procedure, also known as a pancreaticoduodenectomy or a Kausch-Whipple operation, is the primary surgery for pancreatic cancer that occurs within the head of the pancreas, where most pancreatic cancers are located.
There are two common types of the Whipple Procedure. Your surgeon will recommend the one that removes the tumor and affected tissue while safely preserving as much of the pancreas as possible.
It is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, a portion of the bile duct and, if necessary, a portion of the stomach. If you are having a pylorus-sparing Whipple procedure, the part of the stomach is not removed during the operation.
This is a very invasive in-patient surgery, primarily because so many organs are removed and rearranged and the closeness of the pancreas to nerves.
A Whipple procedure does increase your chance of extended survival. However, cure rates depend on the location and stage of your tumor, how much it has spread, and other factors.
The Whipple procedure isn’t only used for cancer of the pancreas. It is also commonly used to treat tumors and other disorders of the pancreas, intestine and bile duct and when a patient has duodenal cancer, which is cancer of the small intestine.
WHAT TO EXPECT DURING A WHIPPLE PROCEDURE SURGERY
A Whipple procedure surgery typically takes 4 to 12 hours to complete. You will be put to sleep under general anesthesia, so you will not feel anything or remember anything.
Once the surgery begins, your surgeon will make a large incision in your abdomen unless you have laparoscopic surgery. In that case, there will be a couple of small incisions.
Your surgeon will first remove the part of your pancreas where the tumor is located, the tissue around the tumor, the small bowel, the lower section of the bile duct, the gall bladder, nearby lymph nodes, and sometimes a part of your stomach.
The final part of the Whipple procedure is reconstructive. Your surgeon will take what’s left of your pancreas and bile duct and attach them to your small intestine, and then the small intestine will be reattached to your stomach.
WHAT TO EXPECT AFTER WHIPPLE PROCEDURE SURGERY
The Whipple procedure is major surgery. You can expect to be in the hospital for one to two weeks following surgery.
You will have pain for a while after the procedure. During your hospital stay, your pain will be managed by your care team. You will be sent home with a pain management plan that will likely include prescription pain medications.
Other post-op medications might also be necessary, such as antibiotics, insulin, digestive enzymes, or medications to prevent clots in your legs. It is important to carefully follow your care team’s and pharmacist’s post-op directions.
You will be given IV fluids and possibly a feeding tube until you can eat and drink again. When you can eat and drink again, you will be on a clear, liquid diet for a few days. Your healthcare team will introduce solid foods once they feel you are ready. Once you are home, your care team might recommend eating smaller, more frequent meals throughout the day and taking only small sips of liquid while eating. If you’ve experienced weight loss, foods higher in calories and protein might also be suggested.
You will need a ride home from the hospital and should have someone at home with you for several days to weeks following your surgery, as it will be difficult to perform even the smallest everyday tasks, such as bathing, eating, and drinking.
Your surgery team will discuss when you can return to normal activities. For most, the timeline is typically 4-6 weeks post-surgery.
POTENTIAL COMPLICATIONS OF WHIPPLE PROCEDURE SURGERY
As with any surgery, there are risks. The Whipple procedure is very complex, with approximately one-third of people having complications.
These can be minor, such as bowel changes, difficulty digesting food, and weight loss. Other complications could include:
- Bleeding
- Infection
- Pancreatitis
- Diabetes (temporary or permanent)
- Fistulas (an abnormal connection between two body parts)
- Leaking of pancreatic juices from the incision site, bowel leakage, or leakage from other organs involved.
To lessen your chance of complications, you will want to closely follow all pre and post-op instructions and select a very skilled surgeon that operates in a hospital that performs frequent Whipple procedures each year.
FINAL THOUGHTS
Compared to other cancers, pancreatic cancer is actually pretty rare. The disease accounts for only about 3% of all cancers, and a person with an average risk of pancreatic cancer only has about a 1% chance of developing the disease.
Family history and poor lifestyle choices such as smoking, excess drinking, and being overweight increase your chances of developing pancreatic cancer. The likelihood of developing pancreatic cancer also increases with age. It is most often diagnosed in those 45 and older.
If you or a family member has been diagnosed with pancreatic cancer, one of the most important things you can do to increase your chances of survival and quality of life is to have an educated and skilled doctor, surgeon and care staff to help you make the best decisions for your unique pancreatic cancer diagnosis.
Our surgeons at The Surgical Clinic have over 40 surgeons with multiple specialties throughout Middle Tennessee. Click here to find the Middle Tennessee location and physician closest to you.