Pancreaticoduodenectomy
1228480
223528795
2008-07-04T13:41:22Z
DOI bot
6652755
Citation maintenance. Removed redundant parameters. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]].
{{Interventions infobox |
Name = {{PAGENAME}} |
Image = |
Caption = |
ICD10 = |
ICD9 = 52.7 |
MeshID = D016577 |
OtherCodes = |
}}
A '''pancreaticoduodenectomy''', '''pancreatoduodenectomy'''<ref name="pmid17723902">{{cite journal |author=Fingerhut A, Vassiliu P, Dervenis C, Alexakis N, Leandros E |title=What is in a word: Pancreatoduodenectomy or pancreaticoduodenectomy? |journal=Surgery |volume=142 |issue=3 |pages=428–9 |year=2007 |pmid=17723902 |doi=10.1016/j.surg.2007.06.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(07)00305-4}}</ref>, '''Whipple procedure''', or '''Kausch-Whipple procedure''', is a major [[surgery|surgical operation]] involving the [[pancreas]], [[duodenum]], and other organs. This operation is performed to treat [[pancreatic cancer|cancerous tumours]] on the head of the [[pancreas]] or cancerous tumors on ducts or vessels near the pancreas. This is still, nevertheless, a major surgical procedure.
== History ==
This procedure was originally described by [[Alessandro Codivilla]] in 1898 and [[Walther Kausch]] in 1912, and later perfected by [[Allen Whipple|Allen Oldfather Whipple]] in the 1930s.<ref>{{WhoNamedIt|synd|3492}}</ref>
This technique is often called the ''Whipple procedure'' since it was named after [[United States|American]] surgeon Dr. [[Allen Whipple]] who devised the procedure in 1935 and subsequently came up with multiple refinements to his technique (surgeons in training are often quizzed on the refinement he made that provided the most improvement in outcomes to that date: the use of non-absorbable silk over absorbable catgut suture). {{Fact|date=April 2007}} The first resection for a [[Ampulla of Vater|periampullary]] cancer was performed by the German surgeon Kausch in [[1909]].
== Anatomy involving the procedure ==
The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply. These arteries run through the head of the pancreas, so that both organs must be removed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum.
The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the [[stomach]]; the first and second portions of the [[duodenum]]; the head of the [[pancreas]]; the [[common bile duct]]; and the [[gallbladder]].
== Pancreaticoduodenectomy in modern medicine ==
The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach ([[antrectomy]]), the gall bladder ([[cholecystectomy]]), the distal portion of the common bile duct (choledochectomy), the head of the [[pancreas]], [[duodenum]], proximal [[jejunum]], and regional [[lymph node]]s. Reconstruction consists of attaching the pancreas to the jejunum ([[pancreaticojejunostomy]]) and attaching the common bile duct to the jejunum ([[choledochojejunostomy]]) to allow digestive juices and [[bile]] to flow into the gastrointestinal tract and attaching the [[stomach]] to the jejunum ([[gastrojejunostomy]]) to allow food to pass through.
Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around 5% nationwide (<2% in high volume academic centers).<ref>[http://www.ddc.musc.edu/ddc_pub/patientInfo/surgeries/whipple.htm Public Information Site | MUSC Digestive Disease Center<!-- Bot generated title -->]</ref>
=== Pancreaticoduodenectomy versus [[total pancreatectomy]] ===
Some authors advocate the removal of the whole pancreas ([[total pancreatectomy]]) instead of just the head.{{Fact|date=April 2007}} However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly severe form of [[diabetes]] (so-called [http://www.medterms.com/script/main/art.asp?articlekey=18392 ''brittle diabetes'']).
=== Pylorus-sparing pancreaticoduodenectomy ===
More recently, the pylorus-sparing pancreaticoduodenectomy (a.k.a. Traverso-Longmire procedure / PPPD) is growing increasingly popular, especially among European surgeons. The main advantage of this technique is that the [[pylorus]], and thus normal gastric emptying, is preserved.<ref name="pmid9785921">{{cite journal |author=Testini M, Regina G, Todisco C, Verzillo F, Di Venere B, Nacchiero M |title=An unusual complication resulting from surgical treatment of periampullary tumours |journal=Panminerva Med |volume=40 |issue=3 |pages=219–22 |year=1998 |pmid=9785921 |doi=}}</ref> However, some doubts remain on whether it is an adequate operation from an [[Surgical oncology|oncological]] point of view. In practice, it shows similar long-term survival as a Whipple's (pancreaticoduodenectomy + hemigastrectomy), but patients benefit from improved recovery of weight after a PPPD, so this should be performed when the tumour does not involve the stomach and the lymph nodes along the gastric curvatures are not enlarged.<ref name=Michalski2007>{{cite journal
| author = Michalski, C.W.
| coauthors = Weitz, J.; Büchler, M.W.; Others,
| year = 2007
| title = Surgery Insight: surgical management of pancreatic cancer
| journal = Nature Clinical Practice Oncology
| volume = 4
| issue = 9
| pages = 526–535
| doi = 10.1038/ncponc0925
}}</ref>
Another controversial point is whether patients benefit from [[retroperitoneal]] [[lymphadenectomy]].
=== Morbidity and mortality ===
Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. In some hospitals, it carries a terrible reputation for high rates of [[morbidity]]. Mortality rates are improved in high-volume hospitals, however this procedure still carries a significant degree of risk (~10%).<ref>{{cite journal |author=Urbach DR, Bell CM, Austin PC |title=Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization |journal=CMAJ |volume=168 |issue=11 |pages=1409–14 |year=2003 |pmid=12771069 |doi=}}</ref> One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.<ref name="pmid17950077">{{cite journal
| author = Syin D, Woreta T, Chang DC, Cameron JL, Pronovost PJ, Makary MA
| title = Publication bias in surgery: implications for informed consent
| journal = J. Surg. Res.
| volume = 143
| issue = 1
| pages = 88–93
| year = 2007
| month = November
| pmid = 17950077
| doi = 10.1016/j.jss.2007.03.035
| url =
}}</ref>
==In popular culture==
The early 1970's medical drama television series "[[Medical Center (TV series)|Medical Center]]" had an episode in which Dr Gannon performed a full Whipple's procedure on a young lady, unsuccessfully- as she died of complications shortly thereafter. It was one of the very few of Dr Gannon's fictitious patients to ever die under his knife.
There is an episode of the comedy television series [[Scrubs (TV series)|Scrubs]] where the intern surgeon Turk is upset because he didn't get assigned a Whipple procedure and shouts, "What's a brother gotta do to get a Whipple around here?!"
There is an episode of [[Grey's Anatomy]], where intern surgeon Christina Yang is trying to get a Whipple procedure- Season 1 Episode 4.
==List of notable people who have had this surgery==
* 2001 [[Chris Rea]]
* 2004 [[Steve Jobs]]
* 2006 [[Randy Pausch]]
==References==
{{reflist}}
==External links==
* [http://www.cancercompass.com/message-board/message/all,4849,0.htm Whipple Surgery Message Board]
* [http://www.pancreasdiseases.com Whipple Operation and Other Surgical Treatments for Pancreatic Diseases including Cancer]
{{Digestive system surgical procedures}}
[[Category:Oncology]]
[[Category:Surgery]]
[[Category:Surgical oncology]]
[[de:Duodenopankreatektomie]]
[[ja:膵頭十二指腸切除術]]
[[pl:Pankreatoduodenektomia]]