Treatment of Pancreatic Cancer with Whipple Procedure (pancreaticoduodenectomy)
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Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery and Hernia Surgery
The Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery and Hernia Surgery offers the full range of services in the areas of its specialization. The department's surgical team successfully performs interventions for diseases of the stomach, esophagus, small intestine, large intestine, rectum, pancreas, liver, gallbladder, and bile ducts. Patients with various types of hernias, including inguinal, umbilical, and incisional hernias, are also operated on here. It should be noted that the department also performs cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), which is an advanced treatment method for peritoneal carcinomatosis. The specialists at the medical facility strive to provide patients with not only effective but also as sparing treatment as possible. That is why the use of minimally invasive surgical techniques is a priority. Such an approach to treatment practically eliminates surgical risks and reduces the duration of a hospital stay. The department has the status of an Expert Center for Liver and Pancreatic Surgery as well as a Competence Center for Upper Gastrointestinal Surgery, which is confirmed by the certification from the German Society for General and Visceral Surgery (DGAV). In addition, the medical facility regularly demonstrates high success rates in the surgical treatment of gastrointestinal cancers, which are confirmed by the certification from the German Cancer Society (DKG).
Department of General, Abdominal Surgery and Surgical Oncology
The Department of General, Abdominal Surgery and Surgical Oncology offers the full range of services in these medical fields. Whenever possible, operations are performed using minimally invasive techniques, which are the gold standard of modern surgery. The outstanding quality of medical care is confirmed by numerous prestigious certificates, including certificates from the German Cancer Society, the German Hernia Society, etc. In addition, the department provides innovative hyperthermic intraperitoneal chemotherapy (HIPEC), which is available only in the most progressive clinics in Europe.
Department of General and Abdominal Surgery, Colorectal Surgery, Hepatopancreatobiliary Surgery, Hernia Surgery and Bariatric Surgery
The Department of General and Abdominal Surgery, Colorectal Surgery, Hepatopancreatobiliary Surgery, Hernia Surgery and Bariatric Surgery provides the full range of surgical treatment in its field of competence. The department's highly qualified surgeons annually perform about 2,000 surgical interventions. Extensive clinical experience allows the specialists to perform even particularly complex operations. The department’s advanced operating rooms serve for surgery to treat gastrointestinal diseases, liver, gallbladder, bile duct, pancreatic, rectal, anal and colon pathologies. The medical facility also successfully performs operations to treat hernias: inguinal, umbilical, and anterior abdominal wall hernias. In addition, the department's doctors deal with the surgical treatment of morbid obesity. Minor traumatic laparoscopic interventions are considered the gold standard, which guarantee a patient minimal risks and rapid postoperative restoration. Surgeons tell the patient in detail about their upcoming treatment and, in every possible way, support them in their recovery.
Department of General and Abdominal Surgery, Colorectal Surgery, Endocrine Surgery and Hernia Surgery
The Department of General and Abdominal Surgery, Colorectal Surgery, Endocrine Surgery and Hernia Surgery offers the full range of modern surgical interventions in the areas of its specialization. Every year, the medical facility performs more than 2,500 surgical interventions on an inpatient and outpatient basis. The department has vast clinical experience in the field of minimally invasive surgery, which allows the patient to avoid severe pain and prolonged hospitalization. In addition, the department offers robotic surgery using the most modern models of the da Vinci surgical system. The medical facility has the status of the Reference Center for Minimally Invasive Surgery and Hernia Surgery. Surgical treatment of cancer is one of the department's clinical priority focuses. A large number of da Vinci robot-assisted interventions are performed here for gastrointestinal cancers. The department holds a leading position in the use of the da Vinci surgical system in the treatment of rectal and sigmoid cancer patients. The operating rooms of the medical facility are equipped with the very latest technology, while hygiene and safety standards are at the highest level as well. Prior to surgery, the patient undergoes a comprehensive examination. Doctors also assess the risks of the upcoming operation and its expected results. With appropriate clinical indications, preference is always given to minimally invasive surgery.
Department of General, Abdominal, Transplant, Hepatopancreatobiliary, Colorectal, Endocrine, Bariatric Surgery and Hernia Surgery
The Department of General, Abdominal, Transplant, Hepatopancreatobiliary, Colorectal, Endocrine, Bariatric Surgery and Hernia Surgery provides the full range of services in the areas of its specialization and holds a leading position at the national and international levels in terms of the number of surgical interventions performed and their success. Of particular interest are operations for treating diseases of the bowel, stomach, esophagus, pancreas, liver, gallbladder, and bile ducts, and endocrine glands. The department's doctors have excellent skills in the surgical treatment of cancer, surgery for liver, kidney, pancreas, and small intestine transplants, and operations for morbid obesity. The department's operating rooms are the pride of the medical facility, since they have all the necessary technical options for performing operations with the da Vinci surgical system, image-guided interventions, and endoscopic surgical procedures, which are characterized by minimal trauma rates.
Department of General, Abdominal and Vascular Surgery
According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel and lung cancer! The department offers all the modern surgical options for the treatment of diseases of the abdominal cavity and blood vessels. The department's doctors have expert knowledge and vast experience in the treatment of colorectal cancer, stomach, esophageal, pancreatic cancers, liver metastases, inflammatory bowel diseases (diverticular disease, Crohn's disease, ulcerative colitis). Also, they specialize in the surgical treatment of vascular pathologies and thyroid diseases.
Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Endocrine Surgery, Hernia Surgery and Bariatric Surgery
The Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Endocrine Surgery, Hernia Surgery and Bariatric Surgery offers the full range of effective surgical treatments in accordance with modern medical standards. Operations of varying complexity are performed on the stomach, colon, pancreas, liver, gallbladder, bile ducts, rectum, thyroid gland, and parathyroid glands in the department's operating rooms every day. The department's primary focus is the surgical treatment of malignant gastrointestinal tumors. The medical facility is certified in this area by the German Cancer Society (DKG). The team of endocrine surgeons specializes in the treatment of diseases of the thyroid gland, parathyroid glands, and adrenal glands. Patients with morbid obesity are also successfully operated on here. In their work, the department’s specialists primarily use minimally invasive surgical techniques, which virtually eliminate trauma to healthy tissue during the intervention. The department's operating suite is equipped with an innovative da Vinci Surgical System, which allows the doctors to perform sparing and high-precision surgical interventions. The specialists of the medical facility strictly adhere to hygiene and safety standards and create the most comfortable conditions for each patient during their hospital stays.
Department of Abdominal, Thoracic and Vascular Surgery
The Department of Abdominal, Thoracic and Vascular Surgery offers all modern surgical interventions in these fields. Specialization covers the treatment of diseases of the abdominal organs, endocrine glands, pathologies of the lungs and chest wall, pathological vascular lesions of all parts of the body. In addition, kidney transplantation and pancreas transplantation are part of the surgeons' tasks. Whenever possible, operations are performed using minimally invasive techniques that have several advantages over classical interventions.
Department of Adult and Pediatric General, Abdominal, Transplant Surgery
According to Focus magazine, the Department of Adult and Pediatric General, Abdominal, Transplant Surgery ranks among the top German medical facilities specializing in bowel cancer treatment! The department performs surgical treatment of general surgical diseases, abdominal pathologies, and also specializes in organ transplantation. Of particular interest are surgical oncology of the abdominal organs, as well as pancreatic and liver surgery. The department annually performs more than 3,000 surgical interventions, which contributes to its credibility at the national level.
Department of General, Abdominal and Transplant Surgery
According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of services in these medical fields and guarantees the first-class medical care at the university level. The department specializes in the treatment of diseases of the abdominal cavity, esophagus and thyroid gland, transplantation of liver, kidney and pancreas. The medical facility has won the reputation of one of the three largest and most successful Transplant Centers in Germany. Also, within the clinical practice, doctors hold highly-specialized consultations on rare diseases and provide 24-hour emergency care.
Department of General, Abdominal, Adult and Pediatric Transplant Surgery
According to the Focus magazine, the Department of General, Abdominal, Adult and Pediatric Transplant Surgery ranks among the top German departments specializing in the treatment of bowel cancer! The department specializes in the treatment of tumors of the gastrointestinal tract, pancreas, liver, and retroperitoneal space (peritoneal carcinomatosis), liver, kidney, pancreas, bowel transplantations in children and adults, as well as the surgical treatment of obesity and general surgical interventions.
Department of Adult and Pediatric General, Abdominal, Hepatobiliary, Endocrine, Thoracic and Hernia Surgery
The Department of Adult and Pediatric General, Abdominal, Hepatobiliary, Endocrine, Thoracic and Hernia Surgery offers the full range of services in these fields. The team of the department's surgeons is rightfully proud of their high professionalism and successfully performs operations of varying degrees of complexity for diseases of the thyroid and parathyroid glands, stomach, esophagus, intestines, pancreas, liver, biliary tract, lungs. The medical facility also performs surgery for inguinal, umbilical and incisional hernias. The department has four high-tech operating rooms equipped with advanced surgical instruments, computer systems, devices for intraoperative ultrasound scanning, radiography, etc. Whenever possible, the department's surgeons perform low-traumatic laparoscopic procedures, after which patients need to spend only a few days in the hospital. The department has 100 beds for patient hospitalization.
Department of General, Abdominal, Endocrine, Colorectal and Bariatric Surgery
According to the Focus magazine, the Department of General, Abdominal, Endocrine, Colorectal and Bariatric Surgery ranks among the top German departments specializing in colon cancer treatment! The department offers the full range of modern surgical interventions. The priority field of clinical activity is cancer surgery, in particular, sparing minimally invasive procedures and robot-assisted interventions. Each patient receives an individual therapy regimen, which is discussed at daily medical boards with doctors from other medical fields. In addition, the responsibility of the medical facility includes surgeries for endocrine disorders and bariatric interventions for morbid obesity. The team of the department's surgeons has a wealth of experience in classical open and minimally invasive procedures on the abdominal organs, as well as specializes in the innovative da Vinci robot-assisted surgery. The department also successfully performs cytoreductive interventions.
Department of General and Abdominal Surgery, Hernia Surgery, Endocrine, Hepatopancreatobiliary, Colorectal, Bariatric, Vascular and Pediatric Surgery
The Department of General and Abdominal Surgery, Hernia Surgery, Endocrine, Hepatopancreatobiliary, Colorectal, Bariatric, Vascular and Pediatric Surgery provides the full range of services in these medical fields. The highly qualified team of the department's surgeons specializes in performing operations of any degree of complexity in the treatment of pathologies of the liver, pancreas, gallbladder, and bile ducts, and diseases of the colon, rectum, and anus, as well as endocrine disorders. The department also performs all modern interventions for vascular pathologies, including aneurysms, carotid stenosis, and intermittent claudication. Patients with morbid obesity can undergo surgical treatment using the most modern and effective techniques. In addition, the medical facility employs experienced pediatric surgeons who provide surgical care to young patients. Operations are performed both on an inpatient and outpatient basis, in accordance with the best recommendations of professional societies. Doctors at the department's state-of-the-art operating rooms perform major interventions, navigation-guided surgery, and minimally invasive surgery to ensure fast recovery of patients.
Department of General and Abdominal Surgery, Hernia Surgery, Colorectal Surgery
According to the Focus magazine, the Department of General and Abdominal Surgery, Hernia Surgery, Colorectal Surgery ranks among the top German medical facilities specializing in the surgical treatment of gallbladder and biliary tract pathologies! The team of the department's surgeons admits patients with benign and malignant gastrointestinal diseases, namely stomach, liver, esophageal, gallbladder and biliary tract, pancreatic, colon and rectal pathologies. The department also carries out treatment for all types of hernias – the medical facility has a quality certificate from the German Hernia Society (DHG). Of particular interest is the resection of malignant tumors of the digestive system. The department's operating rooms have state-of-the-art medical equipment, therefore, in most cases, surgeons can perform interventions without extensive incisions in the skin and soft tissues, but with the use of minimally invasive techniques. Such an approach to surgical treatment greatly facilitates the patient's postoperative recovery process, reduces the risk of complications and excludes severe pain syndrome. The department's surgeons cooperate closely with gastroenterologists, hepatologists, oncologists, radiologists and other doctors from related medical fields. Doctors demonstrate high treatment success rates, use advanced surgical techniques, and observe hygiene and safety standards. Patients can be sure that their health is in the safe hands of leading European specialists.
Department of General and Abdominal Surgery, Hernia Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Thoracic Surgery, Endocrine Surgery and Bariatric Surgery
The Department of General and Abdominal Surgery, Hernia Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Thoracic Surgery, Endocrine Surgery and Bariatric Surgery offers a full range of surgical treatments for diseases of the intestine, stomach, esophagus, pancreas, liver, gallbladder, bile ducts, rectum, anus, thyroid gland, parathyroid glands, and adrenal glands. The department's surgeons are also skilled in inguinal, umbilical, femoral, and incisional hernia repair. An integral part of the department's daily clinical practice is the surgical treatment of diseases of organs in the chest: lung cancer, mediastinal tumors, chest wall tumors, pulmonary emphysema, myasthenia gravis, and pneumothorax. The medical facility also successfully performs bariatric surgery for morbid obesity. The department is part of the Robotic Surgery Center, which performs operations on the small intestine, rectum, stomach, and pancreas, as well as bariatric surgery using the innovative da Vinci robotic system. The department has been awarded the quality certificate by the German Cancer Society (DKG), which indicates outstanding success in the treatment of oncological diseases. Most surgical interventions are performed through a minimally invasive approach with minimal risks. The department's surgeons annually perform over 3,000 operations of varying complexity in inpatient and outpatient settings.
Pancreatic cancer is considered one of the most aggressive cancers. Life expectancy statistics for patients with this diagnosis remains one of the most poor ones.
Content
- Features and functions of pancreas
- Treatment of Pancreatic cancer with Whipple procedure (pancreaticoduodenectomy)
- What is the Whipple procedure (pancreaticoduodenectomy)?
- Whipple procedure (pancreaticoduodenectomy) methods
- How is pancreaticoduodenectomy carried out?
- Benefits of Whipple procedure
- Preparation and preoperative clinical examinations
- Indications for Whipple procedure (pancreaticoduodenectomy)
- Contradictions
- What happens after the surgery?
- Postoperative period
- The cost of the Whipple procedure
- Where can I undergo the Whipple procedure abroad?
- How can I undergo the Whipple procedure abroad?
Features and functions of pancreas
The pancreas is a small organ located deep in the abdomen, under the stomach and behind the duodenum. It is divided into three parts: the head (adjacent to the duodenum), the body and tail (located next to the spleen).
The pancreas secretes several important biological substances, including the hormones responsible for regulating blood sugar levels, as well as some enzymes (referred to as "pancreatic juices"), such as amylase and lipase, which are involved in the breakdown of food.
Treatment of Pancreatic cancer with Whipple procedure (pancreaticoduodenectomy)
The symptoms of pancreatic cancer differ depending on where the cancer is located in the pancreas. Pancreatic cancer may not cause any symptoms at an early stage. As cancer progresses, symptoms appear gradually. Therefore, pancreatic cancer is rarely diagnosed early.
As with any disease, early diagnosis is very important in pancreatic cancer. Over some time, pancreatic cancer causes symptoms such as the upset stomach, bloating, and abdominal pain. But if these signs are ignored, then cancer continues to progress, the symptoms intensify, and only at this stage a patient seeks medical help.
Pancreatic cancer is diagnosed with the help of screening, blood tests, and imaging techniques. These methods provide information about the stage of the disease and the size of the tumor. Since pancreatic cancer is typically detected at an advanced stage, it is important to identify whether cancer has spread to other organs. The treatment scheme mostly depends on the fact of metastases presence.
If the pancreatic cancer tumor is operable, it will be removed by surgery. If the tumor is large, it can be reduced with chemotherapy or radiation therapy and, in some cases, with surgery.
What is the Whipple procedure (pancreaticoduodenectomy)?
Perhaps the most radical and effective way to treat diseases of the head of the pancreas is a pancreaticoduodenectomy or Whipple procedure, which is rightfully one of the most complex interventions in abdominal surgery.
Pancreaticoduodenectomy or Whipple procedure is used for the treatment of benign and malignant neoplasms found in the head of the pancreas.
Pancreatic cancer has a reputation of incurable disease among many doctors, and as a result, many patients are not suggested the treatment they need. A recent US study found that only 30% of patients with cancer were curated to undergo the surgery when it could be helpful.
Many doctors mistakenly consider the Whipple procedure (pancreaticoduodenectomy) for pancreatic cancer as one of the dangerous procedures. Indeed, 10-20 years ago, this operation had a high mortality rate and only a few surgeons performed it professionally. Today, surgeons specializing in pancreatic cancer operations are fluent in the Whipple procedure, and the mortality rate has dropped to 2-4%.
The Whipple procedure (pancreaticoduodenectomy) is a very complex operation that requires a lot of experience and a certain skill level from the surgeon. When surgery is performed in small hospitals or by doctors with little experience, up to 15% of patients with pancreatic cancer can die as a result of surgical complications.
However, when surgery is performed in the specialized cancer centers by experienced surgeons, less than 5% of patients with pancreatic cancer die as a direct consequence of the surgery.
To get the best possible result, it is important to be treated by a surgeon who is experienced in the Whipple procedure and in the best hospitals in the field.
Although a part of the pancreas is going to be removed during surgery, there is usually enough of the remaining pancreas to produce hormones and digestive enzymes.
Whipple procedure (pancreaticoduodenectomy) methods
Whipple procedure can be carried out in the following ways:
- Open surgery
The surgeon makes an incision in the abdominal wall to access the pancreas. This is the most studied and common approach.
- Laparoscopic and robotic surgery
This is a minimally invasive intervention, during which surgical instruments are manipulated by a robot. The surgeon directs the actions of the robot using the control panel. The surgical robot can reproduce very precise and complex movements and manipulate in the areas of the body for which human hands are too large.
Minimally invasive surgery has several advantages, such as the lower risk of blood loss and surgical complications, as well as faster patient recovery. Nevertheless, it can also take more time, which puts additional stress on the body. Sometimes the operation can start with a minimally invasive method, but the risk of complications forces the surgeon to complete the operation openly.
Before the Whipple procedure, the surgeon will explain in detail how it will go and what to expect after. Sometimes, chemotherapy or radiation therapy may precede Whipple procedure (pancreaticoduodenectomy) for pancreatic cancer treatment. In some cases, these clinical treatments are prescribed after surgery.
How is pancreaticoduodenectomy carried out?
Whipple procedure can be performed in two ways, under general anesthesia in both:
- Conventional (open) surgery through an incision in the abdominal cavity
- Laparoscopic intervention through small punctures in the abdomen
During the operation, the surgeon removes the head of the pancreas and sometimes the body of the pancreas. Nearby structures such as part of the small intestine, part of the bile duct, gallbladder, lymph nodes near the pancreas, and sometimes part of the stomach can also be removed.
The remaining bile ducts and pancreas are then attached to the small intestine so that bile and digestive enzymes can still move through the small intestine. The stomach and small intestine are then connected so that food can pass through the digestive tract (intestines).
Diagnostic laparoscopy is sometimes performed before surgery, which allows the surgeon to visually assess the spread of cancer outside the pancreas. If the tumor has metastasized, the surgeon may decide not to proceed with the surgery.
The goal of all types of pancreatoduodenectomy is the same – the removal of the tumor and part of the pancreas, duodenum, and, if necessary, parts of the stomach and gallbladder. The tissues of the removed parts of the gastrointestinal tract are then connected to restore the patency and integrity of the stomach, duodenum, bile ducts, and pancreatic ducts.
The clinical procedures are performed only in a hospital, under the supervision of the teamwork of surgeons and oncologists. The duration of the surgery depends on the complexity and usually is more than 3 hours.
Benefits of Whipple procedure
- The entire tumor is removed
- The ducts of the pancreas and biliary tract are restored
- Practically the only effective method of treating pancreatic cancer
Preparation and preoperative clinical examinations
Before the operation, the patient undergoes an extended preoperative examination. It includes several standard procedures:
- Clinical and biochemical blood tests
- General urine analysis
- Blood tests for HIV, hepatitis B and C, syphilis
- ECG
Besides that, you’ll need to:
- Undergo CT-scan of the abdominal and chest cavity organs
- Do cancer screening – MRI, CT, ultrasound, a blood test for tumor markers
With the results, you’ll need to go to a therapist and surgeon, as well as visit an anesthesiologist, because the intervention is carried out under general anesthesia.
Indications for Whipple procedure (pancreaticoduodenectomy)
- Cancer tumors of the head of the pancreas
- Cancer tumors of the greater duodenal papilla
- Cancer tumors of the duodenum
Contradictions
- Severe and decompensated general therapeutic diseases
- Cachexia, including cancerous one
- Metastases of cancer
What happens after the surgery?
At the end of the surgery, the patient is transferred to the recovery room for two hours so that he can gradually recover from the anesthesia. Then he stays in the intensive care unit, where he is under constant medical supervision for about a day. After that, he is admitted to the surgery department. Whenever possible, the patient is encouraged to move and walk.
Such surgeries usually require hospitalization for 1-2 weeks.
Postoperative period
After Whipple surgery and associated changes in the digestive system, some patients with former pancreatic cancer lose weight significantly. As a rule, within about a month and a half, the digestive system manages to adapt to its new structure and it resumes normal functioning. Therefore, in the postoperative period, patients are advised to eat in small portions and have a snack between meals.
Besides, after the pancreas is resected (especially in cases when the spleen was also excised), patients with pancreatic cancer will be vaccinated to support the immune system.
If the pancreas does not produce enough digestive enzymes after surgery, a patient may develop diarrhea. In this case, a patient may need to take enzyme tablets with food.
If the pancreas doesn't produce enough insulin after surgery, a patient may have high blood sugar. This is extremely rare, but if a patient has high blood sugar after surgery, his healthcare team will support him.
The cost of the Whipple procedure
Even though the procedure is very complicated and complex, its cost in hospitals listed on the Booking Health website is relatively low. As a rule, you can save up to 30-40% of the price by applying for the treatment here.
The hospitals that are represented by Booking Health are trying to make high-tech and complex types of surgery available to the largest possible number of foreign patients with pancreatic cancer at a lower price. Therefore, they are pursuing a cost policy focused primarily on the interests of the patients.
With Booking Health, you can book the Whipple procedure treatment for pancreatic cancer at an affordable price. The cost of the procedure varies in different countries, but we can arrange a trip at a fair price. The cost of pancreatic cancer treatment with Whipple procedure goes as follows:
| Country | Range of prices |
|---|---|
| Germany | from 32,181 EUR to 52,560 EUR |
| Israel | about 31,001 EUR |
| Turkey | from 17,993 EUR to 18,032 EUR |
| South Korea | from 22,424 EUR to 22,565 EUR |
Where can I undergo the Whipple procedure abroad?
Among foreign hospitals, the best success rates in Whipple procedure for pancreatic cancer treatment are shown by:
- Academic Hospital Asklepios Barbek Hamburg, Germany
- Academic Hospital Brothers of Charity Munich, Germany
- Tel Aviv Sourasky Medical Center, Israel
- Medipol Mega University Hospital Istanbul, Turkey
- Samsung Medical Center Seoul, South Korea
How can I undergo the Whipple procedure abroad?
Organizing undergoing of the Whipple procedure abroad by oneself can be challenging. It requires specific knowledge and experience in medical tourism. It is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency that can support you throughout your journey.
Booking Health is the largest and most transparent medical tourism agency in the world. Treatment abroad is arranged by direct cooperation with leading foreign hospitals.
To undergo the Whipple procedure for pancreatic cancer treatment, please leave a request on our website. We will contact you and provide you with all the information necessary.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
