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The big operation for cancers of the head of the pancreas: the surgeon removes the pancreatic head, the duodenum, the gallbladder and part of the bile duct, then reconnects everything.
Named after Allen Whipple (1935), it is the only curative option for pancreatic head, distal bile duct and ampullary cancers, and is offered only when imaging shows the tumour can be fully removed (resectable or borderline resectable after neoadjuvant therapy). It takes 5-8 hours, carries 2-4% mortality and 30-40% major complication rates (pancreatic fistula, delayed gastric emptying), and most patients need enzyme supplements afterwards. Distal pancreatectomy removes the tail instead. Neoadjuvant chemotherapy (FOLFIRINOX) and RAS inhibitors are increasing the share of patients who reach an R0 resection.
The pylorus-preserving Whipple became the standard variant, and the 1980 follow-up is an early record of the exocrine insufficiency that still goes untreated in most patients today.
Every treatment on this roadmap is either a way to reach this operation, a way to make it work better, or a substitute for patients who cannot have it.
Shares Raigmore Hospital, Inverness, Royal Blackburn Hospital (East Lancashire HPB MDT), Royal Stoke University Hospital, Royal Surrey County Hospital, Guildford.
Shares Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen), Solid pseudopapillary neoplasm of the pancreas, Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Colloid (mucinous non-cystic) carcinoma of the pancreas.
Shares Solid pseudopapillary neoplasm of the pancreas, Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas.
Shares Solid pseudopapillary neoplasm of the pancreas, Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas.
Shares Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection), Resectable, borderline resectable and unresectable, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma.
Shares Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Borderline resectable pancreatic ductal adenocarcinoma, Resectable pancreatic ductal adenocarcinoma.
Shares Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas, Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma).
Shares Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas, Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma).