Our Summary

This research paper discusses the outcomes of ten patients who underwent a complex abdominal operation called a pancreatoduodenectomy or Whipple procedure, which is used to treat diseases affecting the pancreas. However, this procedure can sometimes lead to severe complications, requiring additional surgery known as a completion pancreatectomy.

The reasons for this additional surgery included severe infection due to an uncontrolled postoperative pancreatic fistula (a complication where fluid leaks from the pancreas), pancreatic leak and bleeding, postoperative bleeding, and other complications related to the gastrointestinal and hepaticojejunal anastomosis (surgical connection of different parts of the digestive system) coming apart, along with bleeding.

The completion pancreatectomy was performed on average 9 days after the initial Whipple procedure. Out of the ten patients, six (60%) survived the operation and were discharged from the hospital, living an average of 21.3 months after the surgery. Unfortunately, four patients (40%) died shortly after the operation due to severe infection (10%) and multiple organ failure (30%).

The study concludes that completion pancreatectomy, while rarely needed, can be used as a last-resort procedure to manage severe, life-threatening complications after pancreatic surgery.

FAQs

  1. What is the Whipple procedure and what complications can arise from it?
  2. What is a completion pancreatectomy and when is it necessary following a Whipple procedure?
  3. What is the survival rate following a completion pancreatectomy after a Whipple procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about Whipple procedure is to closely follow postoperative instructions and to report any unusual symptoms or complications immediately. It is important to monitor for signs of infection, such as fever or increased pain, as well as any signs of bleeding or leakage at the surgical site. By being vigilant and proactive in seeking medical attention, patients can help prevent and address potential complications after the Whipple procedure.

Suitable For

Patients who are typically recommended for a Whipple procedure include those with:

  • Pancreatic cancer
  • Ampullary cancer
  • Pancreatic neuroendocrine tumors
  • Chronic pancreatitis with complications such as obstruction or pseudocysts
  • Pancreatic cysts with high risk of malignancy

It is important to note that the Whipple procedure is a major surgery with significant risks and complications, so patients must be carefully selected based on their overall health and the specific characteristics of their condition.

Timeline

Before Whipple Procedure:

  1. Patient undergoes diagnostic tests such as imaging studies and blood tests to determine the extent of the pancreatic or periampullary tumor.
  2. Patient may undergo neoadjuvant therapy such as chemotherapy or radiation therapy to shrink the tumor before surgery.
  3. Patient is admitted to the hospital for the Whipple procedure, which involves removal of the head of the pancreas, duodenum, gallbladder, and part of the stomach and small intestine.

After Whipple Procedure:

  1. Patient is closely monitored in the intensive care unit for postoperative complications such as bleeding, infection, and pancreatitis.
  2. Patient may experience pain, nausea, and difficulty eating in the days following the surgery.
  3. Patient is gradually started on a clear liquid diet and then advanced to solid foods as tolerated.
  4. Patient may require additional treatments such as chemotherapy or radiation therapy to prevent recurrence of cancer.
  5. Patient undergoes follow-up appointments with their surgical team to monitor for any signs of complications or recurrence of cancer.

What to Ask Your Doctor

  1. What are the potential complications of a Whipple procedure?
  2. How likely is it that I will need a completion pancreatectomy after the Whipple procedure?
  3. What are the signs and symptoms that may indicate the need for a completion pancreatectomy?
  4. How soon after the Whipple procedure might a completion pancreatectomy be necessary?
  5. What is the success rate of completion pancreatectomy in addressing postoperative complications?
  6. What is the recovery process like after a completion pancreatectomy?
  7. Are there any long-term effects or complications associated with a completion pancreatectomy?
  8. What are the alternatives to completion pancreatectomy for managing postoperative complications after a Whipple procedure?
  9. Are there any specific risk factors that may increase the likelihood of needing a completion pancreatectomy?
  10. How will the decision to perform a completion pancreatectomy be made in my specific case?

Reference

Authors: Bramis K, Vouros D, Kotsarinis V, Frountzas M, Antonakis P, Memos N, Alexakis N, Konstadoulakis M, Toutouzas K. Journal: Am Surg. 2023 Dec;89(12):6348-6350. doi: 10.1177/00031348231175500. Epub 2023 May 9. PMID: 37159926