Our Summary

This research paper discusses the treatment of patients who develop a second, new form of pancreatic cancer (PDAC) after previously having the disease. The incidence of this happening is currently around 6%, but as treatments improve and patients live longer, it’s expected to become more common. The paper presents two cases where patients developed a new PDAC years after their initial one was treated with a specific type of surgery (pancreaticoduodenectomy).

To treat the second cancer, the team used a structured approach to completely remove the pancreas (total pancreatectomy). This was done after the patients received chemotherapy and was performed laparoscopically, or through small incisions using a camera.

The team also used 3D modelling to better understand the anatomy of the patients and to plan the surgery, particularly the critical step of separating the pancreatic limb from a major blood vessel (portal vein). This was done carefully to avoid injury to nearby arteries.

The paper concludes that using 3D modelling helps in planning the surgery and that this approach to treating a second PDAC may become more common as survival rates improve.

FAQs

  1. What is the incidence rate of developing a second form of pancreatic cancer (PDAC) after having the disease previously?
  2. What approach did the research team use to treat the second occurrence of PDAC?
  3. How does 3D modelling aid in the treatment of a second PDAC?

Doctor’s Tip

A helpful tip a doctor might tell a patient about the Whipple procedure is to make sure to follow all post-operative instructions carefully. This may include taking prescribed medications, attending follow-up appointments, and following a specific diet plan. It’s important to communicate any concerns or changes in symptoms to your healthcare team promptly to ensure a successful recovery.

Suitable For

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

  1. Pancreatic cancer (pancreatic adenocarcinoma) that is localized to the head of the pancreas and has not spread to other organs
  2. Ampullary cancer, which is a rare type of cancer that occurs in the ampulla of Vater (where the bile duct and pancreatic duct meet)
  3. Distal bile duct cancer
  4. Chronic pancreatitis with complications such as blockage of the bile duct or duodenum
  5. Neuroendocrine tumors (NETs) of the pancreas that are located in the head of the pancreas

Patients who have previously undergone a Whipple procedure and develop a new form of pancreatic cancer may also be recommended for a total pancreatectomy, especially if the new cancer is localized to the pancreas and has not spread to other organs. This approach may be considered in cases where the patient has already undergone a Whipple procedure and the new cancer is not amenable to other treatments such as chemotherapy or radiation therapy.

Overall, the decision to recommend a Whipple procedure or total pancreatectomy is based on the specific characteristics of the patient’s cancer, including its location, stage, and whether it has spread to other organs. It is important for patients to discuss their treatment options with a multidisciplinary team of healthcare providers, including surgeons, oncologists, and other specialists, to determine the most appropriate course of treatment for their individual case.

Timeline

Before the Whipple procedure:

  1. Patient is diagnosed with pancreatic cancer (PDAC) and undergoes various tests and consultations with healthcare providers to determine the best course of treatment.
  2. Patient may undergo chemotherapy and/or radiation therapy to shrink the tumor before surgery.
  3. Patient undergoes the Whipple procedure, which involves removing the head of the pancreas, part of the small intestine, gallbladder, and bile duct.
  4. Recovery period in the hospital, which can last anywhere from 1-2 weeks.
  5. Patient may experience complications such as infection, bleeding, or leakage from the surgical site.

After the Whipple procedure:

  1. Patient is closely monitored for complications and may require additional treatments such as chemotherapy or radiation therapy.
  2. Patient undergoes regular follow-up appointments and imaging tests to monitor for any signs of cancer recurrence.
  3. Patient may experience long-term side effects such as digestive issues, diabetes, or weight loss.
  4. Patient may need to make lifestyle changes such as dietary modifications or taking pancreatic enzyme supplements.
  5. Patient may require ongoing support from healthcare providers, nutritionists, and other specialists to manage their post-surgical care and overall well-being.

What to Ask Your Doctor

Some questions a patient should ask their doctor about a Whipple procedure include:

  1. What is the purpose of the surgery and how will it benefit me?
  2. What are the risks and potential complications associated with the Whipple procedure?
  3. What is the success rate of the surgery in terms of removing the cancer?
  4. How long will the recovery process take and what can I expect during this time?
  5. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the surgery?
  6. How will the surgery affect my quality of life, particularly in terms of digestion and nutrition?
  7. Are there any long-term effects or risks associated with the Whipple procedure that I should be aware of?
  8. What is the experience and success rate of the surgical team in performing the Whipple procedure?
  9. How will my post-operative care be managed, and what follow-up appointments will be necessary?
  10. Are there any alternative treatment options to consider before proceeding with the Whipple procedure?

Reference

Authors: Salirrosas O, Vega EA, Chirban AM, Harandi H, Cohen M, Anderson A, Bhargava R, Conrad C. Journal: Ann Surg Oncol. 2024 Sep;31(9):6193-6194. doi: 10.1245/s10434-024-15576-3. Epub 2024 Jul 3. PMID: 38958808