Our Summary

This research paper focuses on advanced tumors in the stomach, colon, and the area that includes the liver, pancreas, and bile ducts. These tumors make up more than 20% of all cancers and are hard to treat as they usually have complications in over 70% of cases.

The paper suggests that despite the success of drug therapy, a type of surgery known as multivisceral R0 resections, which often include a procedure called pancreaticoduodenectomy, are the only ways to improve the survival of these patients. These procedures involve the removal of multiple organs or parts of organs at the same time.

The review gathers information from the largest studies of these types of surgeries for advanced cancers of the stomach, the right half of the colon, and the liver, pancreas, and bile ducts area. It presents the immediate and long-term results of treatment, as well as factors that can predict survival.

However, there are some challenges. Most available articles on this topic are case reports or series of cases, and it is rare to find a review that combines the results of several studies in the form of a meta-analysis. Moreover, there are no clear guidelines as to when these extensive surgical interventions should be performed. Prospective and randomized studies, which are more reliable, are almost impossible due to the diverse nature of the patient groups. The paper suggests that collaboration between multiple medical centers is necessary to address these issues.

FAQs

  1. What are multivisceral R0 resections and pancreaticoduodenectomy procedures?
  2. What types of cancers does the research paper focus on?
  3. Why are prospective and randomized studies on these surgical interventions difficult to conduct?

Doctor’s Tip

One helpful tip a doctor might tell a patient about the Whipple procedure is to follow all pre-operative instructions provided by the medical team. This may include fasting before the surgery, stopping certain medications, and undergoing any necessary medical tests. Following these instructions can help ensure a successful surgery and improve recovery outcomes. Additionally, it is important for patients to communicate openly with their healthcare providers about any concerns or questions they may have about the procedure.

Suitable For

Overall, patients who are typically recommended for a Whipple procedure or multivisceral R0 resections are those with advanced tumors in the stomach, colon, liver, pancreas, and bile ducts area. These patients often have complications and are not responsive to drug therapy. The surgery is considered a last resort to improve survival rates in these cases. It is important for medical centers to collaborate and gather more data on the outcomes of these procedures to establish clearer guidelines for patient selection and timing of the surgery.

Timeline

Before the Whipple procedure:

  • Patients may experience symptoms such as jaundice, weight loss, abdominal pain, and changes in bowel habits.
  • They may undergo imaging tests such as CT scans and MRIs to diagnose the tumor and determine its extent.
  • Patients may receive chemotherapy or radiation therapy to shrink the tumor before surgery.
  • They will undergo pre-operative evaluations and preparation for the surgery.

After the Whipple procedure:

  • Patients will be closely monitored in the intensive care unit immediately after surgery.
  • They will gradually start to eat solid foods again and slowly increase their activity level.
  • Patients will need to follow a strict diet and take medications to manage pain and prevent infections.
  • They will have regular follow-up appointments to monitor their recovery and check for any signs of recurrence.
  • Patients may need additional treatments such as chemotherapy or radiation therapy after surgery to prevent the cancer from returning.

What to Ask Your Doctor

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

  • What is the purpose of the Whipple procedure in my specific case?
  • What are the potential risks and complications associated with the Whipple procedure?
  • What is the expected recovery time and rehabilitation process after the Whipple procedure?
  • How will the Whipple procedure affect my digestion and ability to eat?
  • What are the chances of the cancer returning after the Whipple procedure?
  • Will I need additional treatments, such as chemotherapy or radiation therapy, after the Whipple procedure?
  • How many Whipple procedures have you performed, and what is your success rate?
  • Are there alternative treatment options to the Whipple procedure that I should consider?
  • What long-term follow-up care will be necessary after the Whipple procedure?
  • Can you provide me with information on support groups or resources for patients who have undergone the Whipple procedure?

Reference

Authors: Kotelnikov AG, Egorov VI. Journal: Khirurgiia (Mosk). 2024;(11):77-83. doi: 10.17116/hirurgia202411177. PMID: 39584518