Whipple Surgery for Pancreatic Cancer

The Whipple procedure requires extensive surgical skill to safely remove the head of the pancreas; portions of the small intestine, bile duct, gallbladder, and stomach; and some 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.

Studies report that survival rates are higher and complication rates 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. 

At Duke, more than 100 Whipple procedures are performed 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% 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.

Most hospitals that offer Whipple procedures use a large, open incision to reach the organs. In contrast, only a handful of hospitals have surgeons skilled in minimally invasive 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. Minimally invasive Whipple procedures at Duke are performed using a robotic-assisted approach. This holds several potential advantages over the open approach, including less blood loss, reduced pain, a faster recovery, a shorter hospital stay, and reduced readmissions. “Our team includes experts in open pancreatic surgery, minimally invasive surgery, and robotic surgery techniques,” Dr. Zani said.

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.