Whipple Surgery for Pancreatic Cancer

If you have pancreatic cancer, your doctor may suggest the Whipple procedure. This surgery can treat and possibly cure your cancer.

Whipple surgery is the most common operation to remove cancer in the head of the pancreas. Doctors can do this surgery as an open procedure or less invasive robotic surgery.

What Is the Whipple Procedure?

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to take tumors out of the pancreas.

It's a complex technique where surgeons remove part of the pancreas and GI tract. They then rebuild and reroute the pancreas to the small intestine.

The goal is to fully remove cancer to prevent it from growing and spreading to other organs.

Contact Us About Pancreatic Cancer Care

To learn more about pancreatic cancer care or to make an appointment, you can:

Why might I need to have a Whipple procedure?

Whipple surgery may extend your life or potentially cure pancreatic cancer.

Your doctor may suggest Whipple surgery if:

  • Your tumor is in the head — the widest part — of the pancreas. It's on the right side of the belly where the stomach meets the small intestine.
  • The cancer hasn't spread to other organs (liver, lungs, abdominal cavity).
  • You're strong enough to undergo a lengthy, challenging surgery.

How serious is the Whipple procedure?

The Whipple procedure is a long, complex surgery with risks. It involves removing not only the head of the pancreas but other organs as well.

Any major surgery comes with risks, including infection and bleeding.

Other complications from Whipple surgery include:

  • Diabetes.
  • Trouble digesting food.
  • Weight loss.

Types of Whipple Procedures

The open Whipple removes the head of the pancreas, where tumors are most common, with one large incision.

Surgeons also remove the:

  • Bile duct.
  • Gallbladder.
  • Parts of the intestine.
  • Sometimes a portion of the stomach.
  • The lymph nodes around the pancreas to which cancer spreads.

The surgery requires a large incision and a hospital stay of up to 10 days.

UPMC surgeons also perform the robotic Whipple, a less invasive surgery. This technique uses a few minor cuts for a camera and the surgeon's tools, which they control with a computer.

Benefits of the robotic Whipple versus open can include:

  • Faster healing.
  • Fewer and smaller incisions.
  • Fewer risks of setbacks after surgery.
  • Less pain and scarring.
  • Shorter hospital stay.

Almost 80% of people with pancreatic cancer treated at UPMC who get surgery have the Whipple procedure. And up to 70% of people with pancreatic cancer slated for the Whipple can have the robotic option.

UPMC is one of only a few hospitals in the U.S. to offer the robotic Whipple method. Our experts helped pioneer the robotic Whipple and have done more robotic Whipples than anyone else in the country.

According to the American Cancer Society, better Whipple procedure patient outcomes occur at hospitals that do at least 15 to 20 procedures annually.

Your surgeon will work with you to choose what's best for you.

Conditions We Treat With Whipple Procedures

Cancer in the pancreas isn't the only reason someone might need a Whipple surgery. Other reasons for this surgery include:

  • Ampullary cancer.
  • Bile duct cancer.
  • Neuroendocrine tumors.
  • Pancreatic tumors and cysts.
  • Pancreatitis.
  • Small bowel cancer.
  • Trauma to the pancreas.

What Are the Benefits of the Whipple Procedure?

Benefits of the Whipple surgery include:

  • Giving people the best long-term survival rates from pancreatic tumors.
  • Improving symptoms like pain, jaundice, and digestive problems.
  • It's the only cure for pancreatic cancer.

What Are Whipple Procedure Risks and Complications?

Risks of the Whipple surgery include:

  • Bleeding and infection.
  • Delayed stomach emptying.
  • Leaks from the pancreas or bile duct connections.
  • Long, difficult healing times.
  • Short- or long-term diabetes.
  • Trouble keeping food down.

Possible complications of Whipple surgery include:

  • Blood clots.
  • Infection in the lungs, bladder, or incision site.
  • Stomach ulcers or other digestive problems.
  • Weight loss.

Who's a Candidate for Whipple Surgery?

To qualify, your:

  • Tumor must be in the head of the pancreas.
  • Cancer must not have spread to other parts of your body.

To see if surgery is right for you, speak with a surgeon who does a high volume of Whipples.

The Pancreatic Cancer Action Network advises that you always seek a second opinion.

If you decide on a Whipple, choose a hospital like UPMC that does a high volume of them each year.

What to Expect Before, During, and After Whipple Procedures

Your care team will give you details on how to prep for surgery.

They'll also tell you what to expect during and after the procedure.

Before surgery, you:

  • Might need treatment to shrink the tumor to increase the odds of the Whipple's success. This often involves a mix of chemotherapy and radiation.
  • Might need further testing, depending on your age and any other health problems.
  • Will likely need to stop eating, drinking, and taking certain drugs the night before surgery.

On the morning of surgery, after you check into the hospital:

  • A nurse will insert an IV to give you medicine and fluids.
  • You may need an epidural catheter or spinal nerve block. This helps reduce pain as you heal the first few days after surgery.

Based on your type of surgery, it may take four to 8 hours.

During the Whipple procedure, your surgeon removes the:

  1. Head of the pancreas and lower end of the stomach.
  2. The first part of the small intestine (the duodenum).
  3. The gall bladder, part of the bile duct, and surrounding lymph nodes.

The surgeon then joins the:

  • Remaining parts of the stomach and bile duct to the small intestine.
  • Pancreas to the small intestine or stomach.

Right after surgery:

  • You'll likely stay on a surgical floor. If you have other health issues or had a complicated surgery, you might stay in the ICU.
  • Your care team will watch you closely for post-op problems or infections.
  • You won't eat anything by mouth for a few days while your digestive system heals. But you will be up and walking short distances on the first day after surgery.
  • Your doctors will run tests to see if all cancer is gone and make sure your lymph nodes are cancer-free.

After 4-7 days of healing in the hospital, you'll head home.

Home healing can be lengthy, so you'll need someone to help care for you. You may not drive or return to your daily routine for the first four weeks.

Some people also need further cancer treatment after surgery. This may include chemo, radiation, or both. It will help destroy any small cancer cells left after surgery.

After Whipple surgery, you may need to:

  • Adjust your diet to help reduce stomach problems like gas, pain, or diarrhea.
  • Avoid greasy or fatty foods.
  • Eat small meals.

What is the life expectancy after a Whipple procedure?

Patients with non-pancreatic cancers who undergo a Whipple procedure may expect to have a normal life expectancy. The five-year survival rate for Whipple surgery after pancreatic cancer is 20% to 25%.

While it's a complicated surgery, it's the only known cure for pancreatic cancer. And it offers many people hope for full healing.

Learn why you should choose UPMC Hillman for your pancreatic cancer care.