Who Is a Candidate for the Whipple Procedure?
Only about 20% of pancreatic cancer patients are eligible for the Whipple procedure and other surgeries. These are usually patients whose tumors are confined to the head of the pancreas and haven’t spread into any nearby major blood vessels, the liver, lungs, or abdominal cavity. Intensive testing is usually necessary to identify possible candidates for the Whipple procedure. This testing involves making sure that the tumor has not spread, is not involving organs or blood vessels that cannot be removed, and assuring that the patient is in adequate health to undergo major surgery.
The first step in determining whose cancer is able to be removed is to see if it has spread to other organs. Once pancreatic cancer is found in other organs, the focus of therapy is on treating the entire patient by chemotherapy or offering appropriate palliative care to maintain quality of life. In these situations surgery may be undertaken to reroute the food and/or bile but tumor removal is not undertaken.
Next, using high resolution CT or MRI scans, it is determined if the tumor is growing into nearby blood vessels. Deciding if a tumor is surgically removable or not should be determined by an experienced pancreatic surgeon. Sometimes the tumor may grow into or around a critical blood vessel in the upper abdomen. Removing a tumor in this circumstance adds greater difficulty to an already complex operation. Therefore, chemotherapy and radiation are often used to improve the likelihood of being able to remove the tumor. Studies have shown that these complicated operations are safe and effective when completed by experienced surgeons.
The Whipple procedure is a complex operation that requires great technical skill and experience. Studies have shown that optimal outcomes are obtained only in the hands of high volume surgeons. When undertaken by dedicated pancreatic surgeons, the Whipple procedure carries a risk of death of <5%. Complications are still common after the operation, but the experienced pancreatic surgeon is able to lead a team that can safely manage these complications and lead to a full recovery. Knowledge of the complex anatomy, sound technical skills, and experience with the recovery process allows the Whipple procedure to be safely undertaken on even elderly and high risk patients.