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Whipple Surgery for Pancreatic Cancer

Choose a High-Volume Whipple Hospital

Updated September 25, 2018 / Published October 20, 2015

The Whipple procedure requires extensive surgical skill to safely remove the head of the pancreas, and portions of the small intestine, bile duct, gall bladder, stomach, and lymph nodes.

If you have been diagnosed with early-stage pancreatic cancer, the most important decision is where to go for surgery. Up to 30 percent of people with pancreatic cancer may benefit from Whipple surgery, a complex operation that, when combined with chemotherapy, is considered the most effective treatment for pancreatic cancer. Studies confirm that surgeons and hospitals with the most experience and skill performing the Whipple procedure have the best results. Duke surgeons perform more than 100 Whipple procedures annually.

What is Whipple Surgery?

The Whipple procedure requires extensive surgical skill to safely remove the head of the pancreas, and portions of the small intestine, bile duct, gallbladder, stomach, and lymph nodes. The remaining organs are then reconstructed to allow food to pass through the digestive tract. “This allows people to live a normal life after the operation,” said Kevin Shah, MD, a Duke surgical oncologist who specializes in treating people with pancreatic cancer.

Choosing a High-Volume Whipple Hospital

Studies report that survival rates are higher, and complication rates are lower when the Whipple procedure is performed at a high-volume center. The American Cancer Society recommends choosing a center where at least 15 to 20 Whipple procedures are performed annually. 

More than 100 Whipple procedures are performed at Duke annually. “Combined, our surgeons have performed more than 1,500 Whipple procedures,” said Peter Allen, MD, chief of surgical oncology, who specializes in pancreatic cancer. “Our 98 percent survival rate is among the highest in the country.”

This is partly due to the care Duke patients receive before and after surgery, Dr. Allen explained. “Our enhanced recovery program does away with fasting and laxative treatments required the night before surgery,” and uses various methods to reduce pain.  After surgery, most patients are well enough to avoid being in the ICU. The enhanced recovery program also encourages people to eat and move as soon as possible. “The majority of our patients are able to go straight home after discharge from the hospital, while only a very small percentage need time at a skilled nursing or skilled rehabilitation facility prior to going home,” he said.

More than 100 Whipple procedures are performed at Duke annually. “Our 98 percent survival rate is among the highest in the country.”

Peter Allen, MD

Minimally Invasive Whipple Procedures

Most hospitals that offer Whipple procedures use a large, open incision to reach the organs. In contrast, only a handful of hospitals have surgeons who are skilled in laparoscopic Whipple. According to Sabino Zani Jr, MD, a surgical oncologist who specializes in pancreatic cancer, minimally invasive surgery requires much smaller incisions and may speed recovery.  In this procedure, a long, thin tube, known as a laparoscope, equipped with a tiny camera at its tip, is passed through the small incisions. It provides images that guide the surgeon who uses tiny instruments to perform the procedure. Laparoscopic Whipple is sometimes performed robotically, which holds several potential advantages over the open approach, including less blood loss, less pain, a faster recovery, and a shorter hospital stay.

More than 100 minimally invasive Whipple procedures have been performed at Duke since we started doing this advanced surgical procedure in 2010, Dr. Zani said. “Our team includes surgeons who are experts in open pancreatic surgery, minimally invasive surgery and robotic surgery techniques.”

Comprehensive Care at Major Cancer Centers

Chemotherapy and radiation therapy are also critically important to the successful treatment of pancreatic cancer, explained Dan Blazer, MD, a Duke surgical oncologist who treats people with pancreatic cancer. “Only a major cancer center with specialists who focus on treating pancreatic cancer can fully and successfully incorporate these therapies before or after an operation, and manage any complications that may arise,” he said. Ongoing surveillance and monitoring by a team of gastroenterologists, oncologists, specially trained nurses, dietitians, and support staff is key to maximizing your quality of life and extending your survival.

As a National Cancer Institute-designated Cancer Center, and a member of the National Cancer Center Network, Duke is at the forefront of research and treatment for pancreatic and other cancers, Dr. Blazer added. Clinical trials give patients access to new therapies before they are widely available

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Pancreatic Cancer