Pancreaticoduodenectomy

Originally described by Kausch in 1912 and perfected by Allen Oldfather Whipple in the 1930s, pancreaticoduodenectomy is the operation of choice for the management of tumours of the head of the pancreas (the most common site of pancreatic cancer).

The most common technique of pancreaticoduodenectomy, commonly designated the Whipple (or Kausch-Whipple) procedure 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.

Some authors advocate the removal of the whole pancreas (total pancreatectomy) instead of just the head. However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly virulent form of diabetes (so-called brittle diabetes).

More recently, the pylorus-sparing pancreaticoduodenectomy (a.k.a. Traverso-Longmire procedure) 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. However, some doubts remain on whether it is an adequate operation from an oncological point of view.

Another controversial point is whether patients benefit from lymphadenectomy.

Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. In some hospitals, it carries a terrible reputation for high rates of morbidity and mortality. However, clinical trials demonstrate that it is a safe procedure in the hands of experienced surgeons in high-volume centres.