Surgery for pancreatic or bile duct cancer is never a simple decision. Among the options available, the Whipple procedure – also known as pancreaticoduodenectomy – remains the standard of care for certain tumours in the pancreas, bile duct, and small intestine.
In this article, we explain what the procedure involves, who may need it, how to prepare, and what to expect during recovery.
What is the Whipple Procedure?
The Whipple procedure is a major surgery designed to treat pancreatic cancer, tumours, or other conditions in the head of the pancreas, where many of these issues tend to arise.
The surgery involves removing the head of the pancreas, parts of the small intestine (the duodenum), the gallbladder, and sometimes portions of the bile duct and stomach. They are then carefully reconnected to allow for normal digestion and bile flow.
Though the Whipple procedure is challenging and carries risks, it is often the best option for patients dealing with cancer that is localised to the pancreas.
The aim of the surgery is not only to remove the tumour but also to give patients the best chance of survival and quality of life moving forward.
What Does the Whipple Procedure Aim to Resolve?
Whipple surgery primarily aims to address diseases affecting the pancreas, such as:
For patients with localised pancreatic cancer, undergoing pancreaticoduodenectomy offers a chance at curative treatment, giving them the possibility of longer life and relief from the pain and complications associated with untreated pancreatic conditions.
- Pancreatic Cancer: The most common reason for this surgery, when the tumour is confined to the head of the pancreas and has not spread to other organs.
- Chronic Pancreatitis: Severe, long-term inflammation of the pancreas that leads to irreversible damage and complications.
- Pancreatic Cysts or Tumours: Benign tumours or cysts that block the bile duct or cause digestive issues.
- Bile Duct Obstruction: When the bile duct becomes blocked, either by a tumour or other causes, the Whipple procedure can help restore normal bile flow.
How is a Pancreaticoduodenectomy Carried Out?
The Whipple procedure is a delicate, multi-step process that requires careful planning and skill:
To explain it simply, the surgery involves making a large incision in the abdomen and removing the head of the pancreas, duodenum, gallbladder, and sometimes part of the bile duct, stomach, or nearby lymph nodes, depending on the extent of the disease.
After the affected organs are removed, the remaining portions of the pancreas, bile duct, and stomach or small intestine are reconnected to allow digestion to continue as normally as possible.
Because of the number of organs involved and the complexity of reconstruction, the procedure typically takes 6 to 8 hours to complete. It can be carried out either via open surgery or laparoscopically (keyhole surgery).
While the Whipple operation is traditionally carried out via open surgery, with an experienced surgeon, both laparoscopic surgery and open surgery yield similar outcomes.
How Is Whipple Surgery Different from Other Pancreatic Surgeries?
While other surgeries, like the distal pancreatectomy, remove only parts of the pancreas, the Whipple procedure involves the removal of the head of the pancreas along with nearby structures.
This makes it more comprehensive, especially in the treatment of pancreatic cancer or conditions that affect the head of the pancreas.
A total pancreatectomy, on the other hand, involves removing the entire pancreas – this is carried out often in cases of advanced disease.
Who Should Consider a Pancreaticoduodenectomy?
Whipple surgery may be appropriate for patients diagnosed with localised pancreatic cancer or other conditions affecting the head of the pancreas.
It is typically recommended for individuals who are medically fit for major surgery and have no evidence of cancer spread beyond the pancreas.
However, this approach may not be recommended if:
- The cancer has spread to other organs.
- You have other serious medical conditions that increase the risks of surgery.
- Your overall health is poor, and recovery would be unlikely.
If you’re unsure whether you’re a suitable candidate, speak with your surgeon to explore your options.
Preparing for Whipple Surgery
Preparation plays a key role in improving outcomes after Whipple surgery. A full medical review helps determine whether the procedure is suitable and safe. Lifestyle changes and optimising your nutritional status can also support a smoother recovery.
Key steps to take before surgery include:
- Medical assessment: Ensure you are fit for major surgery and that the cancer has not spread.
- Stop smoking and limit alcohol: Both can increase the risk of complications. Stop smoking and limit alcohol: Both can increase the risk of complications.
- Review medications: Inform your doctor if you’re on blood thinners or other long-term medications.Review medications: Inform your doctor if you’re on blood thinners or other long-term medications.
- Improve nutrition: Aim to maintain a healthy weight and muscle mass. If appetite is poor, consider small, frequent meals or supplements.
Weighing Risk and Benefit in Pancreatic Cancer Surgery
Like every surgery, the Whipple procedure comes with its own set of risks. These risks include:
- Delayed gastric emptying, which can cause temporary nausea and vomiting
- A pancreatic fistula due to digestive enzymes leaking into the abdomen
- Difficulty digesting certain foods as parts of the digestive tract are removed or re-routed
- Diabetes
- Bile duct leakage
Despite these risks, the Whipple procedure remains one of the most effective – and at times the only – potentially curative treatments for cancers of the pancreas, bile duct, and duodenum.
With experienced surgical teams and improved post-op care, outcomes have steadily improved:
In many cases, the potential benefits far outweigh the risks, especially when surgery is performed by an experienced surgeon.
Concerned about a diagnosis?
Consult our specialist for treatment guidance or a second opinion.
Dr Thng Yongxian
Hepatopancreatobiliary & General Surgeon
Dual Fellowship-Trained Specialist
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS
Dr Thng Yongxian
Hepatopancreatobiliary & General Surgeon
Dual Fellowship-Trained Specialist
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS
Final Thoughts
The Whipple procedure is a complex operation, but for many patients, it represents the best chance of long-term remission, improved quality of life, or even cure. If you’re considering this procedure, it’s important to have open discussions with your healthcare team to fully understand the risks, benefits, and whether it’s appropriate for your condition.
If you have any questions, feel free to get in touch.
This article is part of Dr Thng’s ongoing effort to make educational content on hepatopancreatobiliary health accessible to all. For more articles and resources on related topics, click here.
Dr Thng Yongxian
Senior Consultant HEPATOPANCREATOBILIARY & GENERAL SURGEON
Dr Thng Yongxian is a fellowship-trained surgeon and surgical oncologist with a focus on minimally invasive liver and pancreatic surgery. He brings extensive surgical experience in managing routine and complex conditions, including cancers of the hepatopancreatobiliary system.
- Bachelor of Medicine & Bachelor of Surgery (MBBS), National University of Singapore
- Membership of the Royal College of Surgeons (MRCS), Ireland
- Master of Medicine (MMed), General Surgery, Singapore
- Fellow of the Royal College of Surgeons (FRCS), Edinburgh
- Fellow of the Academy of Medicine (FAMS), Singapore
Languages Spoken: English, Mandarin, Cantonese, Hokkien, Teochew
Dr Thng Yongxian is a hepatopancreatobiliary (HPB) and general surgeon with subspecialty expertise in minimally invasive liver and pancreatic surgery. He practises at Mount Elizabeth (Orchard and Novena), Parkway East, Mount Alvernia Hospital and Gleneagles Hospital.
Previously serving as Consultant and Clinical Lead for the HPB Division at National University Health System (NUHS), Dr Thng pioneered the use of laparoscopic techniques for complex HPB procedures — enabling up to 80% of such surgeries to be performed minimally invasively under his leadership.
Dr Thng received his medical degree from the National University of Singapore and underwent advanced surgical training locally and internationally, including a clinical fellowship at Seoul National University Hospital in South Korea. He is a Fellow of the Royal College of Surgeons (Edinburgh) and the Academy of Medicine, Singapore.
Committed to delivering value-driven care, Dr Thng has held leadership roles in national initiatives to improve surgical outcomes and reduce patient costs. He also actively contributes to research and education, with international presentations, published work on complex liver resections, and experience training the next generation of surgeons.
References:
- Wang, M., Pan, S., Qin, T., Xu, X., Huang, X., Liu, J., Chen, X., Zhao, W., Li, J., Liu, C., Li, D., Liu, J., Liu, Y., Zhou, B., Zhu, F., Ji, S., Cheng, H., Li, Z., Li, J., Tang, Y., … Qin, R.
(2023). Short-Term Outcomes Following Laparoscopic vs Open Pancreaticoduodenectomy in Patients With Pancreatic Ductal Adenocarcinoma: A Randomized Clinical Trial. JAMA surgery, 158(12), 1245–1253. https://doi.org/10.1001/jamasurg.2023.5210
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