Pancreaticoduodenectomy – i.e The Whipple Procedure
This is the most common operation to remove a cancer of the exocrine pancreas. It is also sometimes used to treat pancreatic NETs.
Click to watch a video of The Whipple Procedure
During this operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas as well. Nearby structures such as part of the small intestine, part of the bile duct, the gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach are also removed. The remaining bile duct and pancreas are then attached to the small intestine so that bile and digestive enzymes can enter the small intestine. The pieces of the small intestine (or the stomach and small intestine) are then reattached as well so that food can pass through the digestive tract.
In the best of hands, many patients still suffer complications from the surgery. These can include:
- Leaking from the various connections among organs that the surgeon has to make.
- Trouble with the stomach emptying itself after eating.
Other, longer-term complications can include weight loss, trouble digesting some foods, changes in bowel habits, and diabetes in some people.
In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. This operation is used more often to treat PNETs found in the tail and body of the pancreas. It is seldom used to treat cancers of the exocrine pancreas because these tumors have usually already spread by the time they are found.
This operation was once used for tumors in the body or head of the pancreas. It removes the entire pancreas and the spleen. It is now seldom used to treat exocrine cancers of the pancreas because there doesn’t seem to be an advantage in removing the whole pancreas.
It is possible to live without a pancreas. But when the entire pancreas is removed, people are left without any islet cells, the cells that make insulin and other hormones that help maintain blood sugar levels. These people develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.
Palliative care is NOT hospice care
Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. It is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.
Palliative care can address a broad range of issues, integrating an individual’s specific needs into care. A palliative care specialist will take the following issues into account for each patient: physical effects, emotional need, coping mechanisms, spiritual needs, caregiver needs and practical needs such as financial worries or insurance navigation.
A cancer patient should ask their oncologist for a referral, or you can view lists of palliative care doctors by state from the Center to Advance Palliative Care.
Nikki Mitchell benefited from palliative care, and her caregiver Rhonda Miles, wishes it was offered at the beginning of her cancer diagnoses, instead of at the end. Read Rhonda’s blog post about this type of care, as well as the National Cancer Institute’s FAQs.