Our Summary

This study looks at the long-term effects of a particular surgery (known as an extended Whipple procedure) on patients, focusing on complications that may arise from specific alterations made to the splenic vein (a blood vessel in the spleen). A concern has been whether closing up or tying off the splenic vein without reconnecting it elsewhere can lead to a condition known as sinistral portal hypertension.

The researchers looked into post-surgery changes in the patients’ veins and the potential consequences of tying off the splenic vein. They studied patients who had undergone this procedure between 2009 and 2014. The splenic vein was not reconnected, and a specific junction of veins was always removed during the procedure.

The team found that the body developed two new routes for blood flow following the surgery. Almost all patients developed an “inferior” route, which reconnected the remaining part of the splenic vein to another major vein through smaller, connecting veins. Two-thirds also developed a “superior” route, connecting the remaining part of the splenic vein directly to the liver’s portal vein.

There were no instances of gastrointestinal bleeding, a potential risk of the procedure. Importantly, the average platelet count (a measure of the blood’s ability to clot) and spleen size did not significantly change after the procedure. The surgeries were long but did not lead to many severe complications.

For patients with a specific type of cancer (adenocarcinoma), the median survival rate after the procedure has not been determined yet.

The study concluded that patients who have their splenic vein tied off during this procedure are protected from potential complications by the development of these new blood flow routes. The omentum and veins of the colon play a crucial role in these new routes.

FAQs

  1. What is the aim of the study on the Whipple procedure?
  2. What is the significance of the splenic vein in the extended Whipple procedure?
  3. What are the long-term results of the extended Whipple procedure?

Doctor’s Tip

A helpful tip a doctor might give a patient about the Whipple procedure is to be aware of the potential development of venous collateral routes after the surgery, specifically the inferior and superior routes that connect the residual splenic vein to other veins in the body. These collateral routes help prevent the development of sinestral portal hypertension. It is important for patients to understand the potential changes in their anatomy post-surgery and to follow up with their healthcare provider for monitoring and management of any potential complications.

Suitable For

Patients who are typically recommended for a Whipple procedure are those with pancreatic cancer, ampullary cancer, bile duct cancer, or other tumors in the area of the pancreas. These patients may benefit from a Whipple procedure to remove the affected part of the pancreas, bile duct, and small intestine.

In the case of an extended Whipple procedure where the splenic vein may need to be ligated, patients with advanced tumors that require a more extensive resection may be recommended for this procedure. Patients who have a high risk of developing sequelae of sinistral portal hypertension, such as those with tumors involving the splenic vein, may also be candidates for an extended Whipple procedure.

Overall, the decision to recommend a Whipple procedure, whether standard or extended, is based on the specific characteristics of the patient’s tumor, the extent of the disease, and the potential benefits and risks of the surgery. It is important for patients to discuss their individual situation with their healthcare team to determine the most appropriate treatment plan.

Timeline

Before the Whipple procedure:

  • Patient undergoes preoperative evaluation and testing to determine candidacy for surgery
  • Patient may undergo chemotherapy or radiation therapy prior to surgery
  • Patient is admitted to the hospital for the Whipple procedure
  • Patient undergoes the Whipple procedure, which involves removing a portion of the pancreas, small intestine, gallbladder, and bile duct
  • Patient is monitored closely in the hospital postoperatively for complications
  • Patient may experience pain, nausea, and difficulty eating in the immediate postoperative period
  • Patient is discharged from the hospital once stable

After the Whipple procedure:

  • Patient is closely monitored for complications such as infection, bleeding, and leakage from the surgical site
  • Patient may require a temporary feeding tube to help with nutrition
  • Patient gradually resumes eating and may require pancreatic enzyme supplements
  • Patient may undergo chemotherapy or radiation therapy as part of their treatment plan
  • Patient is followed up regularly by their healthcare team for surveillance and management of any long-term effects of the surgery
  • Patient may experience changes in digestion, weight loss, and fatigue in the long term
  • Patient may have a reduced risk of pancreatic cancer recurrence in the future.

What to Ask Your Doctor

  1. What is the purpose of the Whipple procedure?
  2. What is the specific reason for considering an extended Whipple procedure in my case?
  3. What are the potential risks and complications associated with an extended Whipple procedure, particularly in relation to ligation of the splenic vein?
  4. How will the ligation of the splenic vein affect my overall recovery and long-term health?
  5. Will I need any additional monitoring or follow-up care after the procedure to check for sequelae of sinistral portal hypertension?
  6. What can I expect in terms of postoperative pain management and recovery time?
  7. Are there any lifestyle changes or dietary restrictions I should be aware of after the procedure?
  8. What is the success rate for an extended Whipple procedure in terms of long-term survival for patients with my condition?
  9. Are there any alternative treatment options to consider aside from the Whipple procedure?
  10. How many times have you performed an extended Whipple procedure, and what is your experience with this specific type of surgery?

Reference

Authors: Rosado ID, Bhalla S, Sanchez LA, Fields RC, Hawkins WG, Strasberg SM. Journal: J Gastrointest Surg. 2017 Mar;21(3):516-526. doi: 10.1007/s11605-016-3325-6. Epub 2016 Dec 5. PMID: 27921207