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The Whipple Procedure and Other Pancreas Surgeries

Drs. Wolfgang, Edil and Lennon meet with a patient Drs. Wolfgang and Lennon meet with a patient.

At the time of diagnosis, pancreatic cancer is often found to have already metastasized (spread to other organs) and these patients will not benefit from surgical removal of their primary tumor.  Surgery can be performed as a potentially curative measure if the cancer is contained within the pancreas and has not spread to blood vessels, lymph nodes or other organs. This treatment option should be discussed with your physician to see if it is a viable option. The type of operation performed for removal of pancreatic cancer is based on the location of the tumor.  For tumors of the head and neck of the pancreas a Whipple procedure, (also called a pancreaticoduodenectomy) is performed.  This is a complex operation perfected at Johns Hopkins.  Tumors that grow in the body and tail of the pancreas are removed  through a surgery known as a distal pancreatectomy

Johns Hopkins performs more pancreas cancer surgeries than any other institution in the country. Each year, our surgeons perform approximately 350 Whipple procedures and 100 distal pancreatectomies. Our team of experienced surgeons also includes the most experienced nurses and experts in gastroenterology, cancer genetics, and social work to provide the best and most complete care to our patients.

The Whipple Procedure

At Johns Hopkins, our surgeons have made significant improvements to the Whipple procedure, the primary surgical treatment for pancreatic cancer that occurs within the head of the gland (also called a pancreaticoduodenectomy). Today, our surgeons perform a high volume of these procedures and have lessened the complications during and after surgery.

We also have minimally invasive or laparoscopic options for certain patients with tumors in the pancreas. Our team can help determine whether you are a candidate for these procedures.

Until recently, pancreatic surgery was associated with a very high risk of surgically related mortality. Johns Hopkins Medicine surgeon honed the Whipple procedure to the point where the mortality rate now stands at 2 percent, when performed by experienced surgeons. Dr. Cameron has performed more than 2,000 of these surgeries -- more than anyone else in the world. He has trained a team of pancreatic surgeons at Johns Hopkins Medicine to carry on his legacy.

 During the Whipple procedure, surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct, the gallbladder, and associated lymph nodes. In some cases, the entire duodenum and a portion of the stomach must be removed. The surgery takes on average six hours to complete. Most patients stay in the hospital for one to two weeks following the Whipple procedure.

Minimally Invasive Pancreas Surgery

Minimally invasive or laparoscopic surgical techniques can sometimes be used in pancreatic surgery, depending upon factors such as location of the tumor.  Laparoscopic procedures are performed with small incisions in the abdomen through which telescope-guided instruments are placed. Conventional surgeries require a longer incision and wider opening of the abdomen. With laparoscopic procedures, surgeons are generally able to reduce blood loss and risk of infection for the patient.

Our surgical oncologists can help determine whether you are a candidate for a minimally invasive procedure – we are committed to offering patients the best surgery for their individual needs

Distal Pancreatectomy

In a distal pancreatectomy, surgeons remove tumors of the body and the tail of pancreas and leave the head of the pancreas intact. This surgery usually takes less time and has a shorter recovery period than surgeries like the Whipple procedure that remove the head of the pancreas.

Checking Your Margins

At Johns Hopkins, our surgeons and pathologists work together to make sure that each patient's tumor margins around the surgical excision are evaluated during surgery. Margins are the edge or border of the pancreas cancer tissue that is removed during surgery. When a pathologist describes a margin as negative or clean, it means the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. When the margin is described as positive or involved, it suggests that all of the cancer has not been removed. Checking tumor margins is a process done under the microscope by our pathologists in real time, during surgery. This enables our pathologists to guide the surgical team on whether cancer cells remain in the borderline areas of the tumor and whether or not more tissue needs to be removed, if possible. In some cases, not all cancerous cells can be completely removed.

Total Pancreatectomy

This procedure is the least common of all of the surgeries performed for pancreas cancer and is used when tumors extend throughout the pancreas. In a total pancreatectomy, surgeons remove the entire pancreas and the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. Most patients will be in the hospital for one to two weeks. Removing the entire pancreas leaves patients unable to produce enzymes for digestion and insulin for controlling blood glucose (sugar) level. As a result, following surgery, patients take supplemental enzymes and insulin for the rest of their lives.

Improving Standards of Surgical Care Through Research

With the availability of laparoscopic pancreas cancer removal, Johns Hopkins surgical oncologists are studying whether systemic chemotherapy that is given earlier to patients because of shortened recovery periods with laparoscopy is safe and feasible.  Because pancreas cancer is an aggressive disease, the goal is to deliver systemic therapies as quickly as possible, and this study will determine whether laparoscopic procedures may help reach that goal.
Surgical and medical oncologists at Johns Hopkins also are studying the use of experimental vaccines given before surgery to remove the pancreas in an effort to boost the immune system and help it identify and kill cancer cells.
Another study will involve using radiotherapy during surgery for pancreas cancer tumors that are anatomically difficult to remove.  With these tumors, there is a good chance that pancreas cancer cells may remain in the margins surrounding tissue that is removed. Radiation delivered externally through the stomach can be given only in low doses, so Johns Hopkins scientists are planning to study whether high doses of radiation in seed implants positioned next to the tumor site during surgery could be more effective than external radiation. 

The Pancreas Surgery Team

Photo of Dr. Nita Ahuja, M.D.

Ahuja, Nita, M.D.

Professor of Surgery
Professor of Oncology
Professor of Urology
Director of Sarcoma and Peritoneal Surface Malignancy Program
Vice Chair of Academic Affairs, Department of Surgery
Chief, Division of Surgical Oncology
Photo of Dr. John L Cameron, M.D.

Cameron, John L, M.D.

Professor of Surgery
Professor of Oncology
Alfred Blalock Distinguished Service Professor of Surgery
Photo of Dr. Jin He, M.D., Ph.D.

He, Jin, M.D., Ph.D.

Assistant Professor of Surgery
Assistant Professor of Oncology
Photo of Dr. Fabian McCartney Johnston, M.D., M.H.S.

Johnston, Fabian McCartney, M.D., M.H.S.

Assistant Professor of Surgery
Co-Director of the Peritoneal Surface Malignancy Program
Photo of Dr. Martin Adel Makary, M.D., M.P.H.

Makary, Martin Adel, M.D., M.P.H.

Professor of Surgery
Surgical Director, Johns Hopkins Multidisciplinary Pancreatitis Center
Chief, Minimally-Invasive Pancreas Surgery
Photo of Dr. Matthew John Weiss, M.D.

Weiss, Matthew John, M.D.

Assistant Professor of Surgery
Assistant Professor of Oncology
Surgical Director, Johns Hopkins Liver and Pancreas Cancer Multidisciplinary Clinics
Director, Complex Surgical Oncology Fellowship Program, Johns Hopkins Medicine
Surgical Director, Johns Hopkins Liver Cancer Multidisciplinary Clinic
Photo of Dr. Christopher Lee Wolfgang, M.D., M.S., Ph.D.

Wolfgang, Christopher Lee, M.D., M.S., Ph.D.

Professor of Surgery
Professor of Oncology
Professor of Pathology
Director, Hepatobiliary and Pancreatic Surgery

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