Pancreaticoduodenectomy: Difference between revisions
m →List of notable people who have had this surgery: Per his Wikipedia page, S. Jobs is a co-founder of Apple |
tidy |
||
| Line 1: | Line 1: | ||
{{Refimprove|date=March 2010}} |
|||
{{Interventions infobox | |
{{Interventions infobox | |
||
Name = Pancreaticoduodenectomy | |
Name = Pancreaticoduodenectomy | |
||
| Line 8: | Line 9: | ||
OtherCodes = | |
OtherCodes = | |
||
}} |
}} |
||
A '''pancreaticoduodenectomy''', '''pancreatoduodenectomy'''<ref name="Fingerhut">{{cite journal |author=Fingerhut A |
A '''pancreaticoduodenectomy''', '''pancreatoduodenectomy''',<ref name="Fingerhut">{{Clarify|date=March 2010|reason=link doesn't send one quite as cited. this editor was unable to proceed past "garden wall"}}{{cite journal |author=Fingerhut, A.; Vassiliu, P.; Dervenis, C.; Alexakis, N.; Leandros, E.|title=What Is in a Word: Pancreatoduodenectomy or Pancreaticoduodenectomy? |journal=[[Surgery (journal)|Surgery]] |volume=142 |issue=3 |pages=428–9 |year=2007 |pmid=17723902 |doi=10.1016/j.surg.2007.06.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(07)00305-4}}</ref> '''Whipple procedure''', or '''Kausch-Whipple procedure''', is a major [[surgery|surgical operation]] involving the [[pancreas]], [[duodenum]], and other organs. This operation is performed to treat [[pancreatic cancer|cancerous tumours]] on the head of the [[pancreas]], malignant tumors involving [[common bile duct]] or duodenum near the pancreas. |
||
== History == |
== History == |
||
This procedure was originally described by [[Alessandro Codivilla]] in 1898. The first resection for a [[Ampulla of Vater|periampullary]] cancer was performed by the German surgeon [[Walther Kausch]] in 1909 and described by Kausch in 1912. |
This procedure was originally described by [[Alessandro Codivilla]], an [[Italian people|Italian]] surgeon, in 1898. The first resection for a [[Ampulla of Vater|periampullary]] cancer was performed by the [[Germans|German]] surgeon [[Walther Kausch]] in 1909 and described by Kausch in 1912. |
||
It is often called the ''Whipple procedure'', after the [[United States|American]] surgeon [[Allen |
It is often called the ''Whipple procedure'', after the [[People of the United States|American]] surgeon [[Allen Whipple]] who devised a perfected version of the surgery in 1935<ref>{{WhoNamedIt|synd|3492}}</ref> and subsequently came up with multiple refinements to his technique. |
||
== Anatomy involving the procedure == |
== Anatomy involving the procedure == |
||
The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the |
The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply. These arteries run through the head of the pancreas, so that both organs must be removed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum. |
||
The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the [[stomach]]; the first and second portions of the |
The most common technique of a pancreaticoduodenectomy consists of the ''en bloc'' removal of the [[Anatomical terms of location#Proximal and distal|distal]] segment ([[antrum]]) of the [[stomach]]; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the [[gallbladder]]. |
||
== Pancreaticoduodenectomy in modern medicine == |
== Pancreaticoduodenectomy in modern medicine == |
||
The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach ([[antrectomy]]), the gall bladder ([[cholecystectomy]]), the distal portion of the common bile duct (choledochectomy), the head of the |
The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach ([[antrectomy]]), the gall bladder ([[cholecystectomy]]), the distal portion of the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal [[jejunum]], and regional [[lymph node]]s. Reconstruction consists of attaching the pancreas to the jejunum ([[pancreaticojejunostomy]]) and attaching the common bile duct to the jejunum ([[choledochojejunostomy]]) to allow [[Gastric juice|digestive juices]] and [[bile]] respectively to flow into the gastrointestinal tract and attaching the stomach to the jejunum ([[gastrojejunostomy]]) to allow food to pass through. |
||
Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around |
Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around five percent in the United States (less than two percent in high-volume academic centers).<ref>{{Dead link|date=March 2010}}[http://www.ddc.musc.edu/ddc_pub/patientInfo/surgeries/whipple.htm Public Information Site | MUSC Digestive Disease Center<!-- Bot generated title -->]</ref> |
||
=== Pancreaticoduodenectomy versus total pancreatectomy === |
=== Pancreaticoduodenectomy versus total pancreatectomy === |
||
Some authors advocate the removal of the whole pancreas ([[total pancreatectomy]]) instead of just the head.{{Citation needed|date=April 2007}} However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly severe form of [[diabetes]] called [[brittle diabetes]]. Sometimes the pancreaticojejunostomy may not hold properly after the completion of the operation and infection may spread inside the patient. This may lead to another operation shortly thereafter in which the remainder of the pancreas (and sometimes the spleen) is removed to prevent further spread of infection and possible morbidity. |
Some authors advocate the removal of the whole pancreas ([[total pancreatectomy]]) instead of just the head.{{Citation needed|date=April 2007}} However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly severe form of [[diabetes]] called [[brittle diabetes]]. Sometimes the pancreaticojejunostomy may not hold properly after the completion of the operation and [[infection]] may spread inside the patient. This may lead to another operation shortly thereafter in which the remainder of the pancreas (and sometimes the [[spleen]]) is removed to prevent further spread of infection and possible [[Disease#Morbidity|morbidity]]. |
||
=== Pylorus-sparing pancreaticoduodenectomy === |
=== Pylorus-sparing pancreaticoduodenectomy === |
||
More recently, the pylorus-sparing pancreaticoduodenectomy ( |
More recently, the pylorus-sparing pancreaticoduodenectomy (also known as Traverso-Longmire procedure/PPPD) is growing increasingly popular, especially among [[Europe]]an surgeons. The main advantage of this technique is that the [[pylorus]], and thus normal gastric emptying, is preserved.<ref name="pmid9785921">{{cite journal |author=Testini, M.; Regina, G.; Todisco, C.; Verzillo, F.; Di Venere, B.; Nacchiero, M.|title=An Unusual Complication Resulting from Surgical Treatment of Periampullary Tumours |journal=[[Panminerva Med]] |volume=40 |issue=3 |pages=219–22 |year=1998 |pmid=9785921 |doi=}}</ref> However, some doubts remain on whether it is an adequate operation from an [[Surgical oncology|oncological]] point of view. In practice, it shows similar long-term survival as a Whipple's (pancreaticoduodenectomy + hemigastrectomy), but patients benefit from improved recovery of weight after a PPPD, so this should be performed when the tumour does not involve the stomach and the lymph nodes along the gastric curvatures are not enlarged.<ref name=Michalski2007>{{cite journal |
||
| author = Michalski, C.W. |
| author = Michalski, C.W. |
||
| coauthors = Weitz, J.; Büchler, M.W.; |
| coauthors = Weitz, J.; Büchler, M.W.; others |
||
| year = 2007 |
| year = 2007 |
||
| title = Surgery Insight: |
| title = Surgery Insight: Surgical Management of Pancreatic Ccancer |
||
| journal = Nature Clinical Practice Oncology |
| journal = [[Nature Clinical Practice Oncology]] |
||
| volume = 4 |
| volume = 4 |
||
| issue = 9 |
| issue = 9 |
||
| pages = |
| pages = 526–535 |
||
| doi = 10.1038/ncponc0925 |
| doi = 10.1038/ncponc0925 |
||
}}</ref> |
}}</ref> |
||
| Line 46: | Line 47: | ||
Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. |
Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure. |
||
Many studies have shown that hospitals where a given operation is performed more often will have better overall results, and especially so in the case of more complex procedures, such as pancreaticoduodenectomy. A frequently cited study published in The New England Journal of Medicine found operative mortality |
Many studies have shown that hospitals where a given operation is performed more often will have better overall results, and especially so in the case of more complex procedures, such as pancreaticoduodenectomy. A frequently cited study published in ''[[The New England Journal of Medicine]]'' found operative [[mortality rate]]s to be four times higher (16.3 percent vs. 3.8 percent) at low-volume (averaging less than one pancreaticoduodenectomy per year) hospitals than at high-volume (16 or more per year) hospitals. Even at high-volume hospitals, morbidity has been found to vary by a factor of almost four depending on the number times the surgeon has previously performed the procedure.<ref name="Pri-Med">[http://www.patienteducationcenter.org/aspx/HealthELibrary/HealthETopic.aspx?cid=L0409b "The Whipple Procedure"] Pri-Med Patient Education Center, [[Harvard Health Publications]]</ref> |
||
One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.<ref name="pmid17950077">{{cite journal |
One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.<ref name="pmid17950077">{{cite journal |
||
| author = Syin D |
| author = Syin, D.; Woreta, T.; Chang, D.C.; Cameron, J.L.; Pronovost, P.J., Makary, M.A. |
||
| title = Publication |
| title = Publication Bias in Surgery: Implications for Informed Consent |
||
| journal = |
| journal = [[Journal of Surgical Research]] |
||
| volume = 143 |
| volume = 143 |
||
| issue = 1 |
| issue = 1 |
||
| pages = |
| pages = 88–93 |
||
| year = 2007 |
| year = 2007 |
||
| month = November |
| month = November |
||
| Line 63: | Line 64: | ||
==List of notable people who have had this surgery== |
==List of notable people who have had this surgery== |
||
<!-- Please include a valid "pancreaticoduodenectomy" or "pancreatoduodenectomy" or "Whipple procedure" or "Kausch-Whipple procedure" <ref> - thanks --> |
<!-- Please include a valid "pancreaticoduodenectomy" or "pancreatoduodenectomy" or "Whipple procedure" or "Kausch-Whipple procedure" <ref> - thanks --> |
||
* 2001: [[Chris Rea]], singer-songwriter |
* 2001: [[Chris Rea]],{{Citation needed|March 2010}} [[singer-songwriter]] |
||
* 2004: [[Steve Jobs]],<ref>[http://money.cnn.com/2008/03/02/news/companies/elkind_jobs.fortune/ |
* 2004: [[Steve Jobs]],<ref>Peter Elkind, Peter; Burke, Doris (March 5, 2008). [http://money.cnn.com/2008/03/02/news/companies/elkind_jobs.fortune/index.htm "The Trouble with Steve Jobs — Jobs Likes To Make His Own Rules, Whether the Topic Is Computers, Stock Options, or Even Pancreatic Cancer. The Same Traits That Make Him a Great CEO Drive Him To Put His Company, and His Investors, at Risk."] ''(see page four of article)''. ''[[Fortune (magazine)|Fortune]]'' (''via'' ''[[CNNMoney.com]]''). Accessed March 2, 2010.</ref> co-[[founder (company)|founder]] of [[Apple Inc.]] |
||
* 2007: [[Randy Pausch]],<ref name="Pri-Med" /> originator of the inspirational |
* 2007: [[Randy Pausch]],<ref name="Pri-Med" /> originator of the inspirational ''[[Really Achieving Your Childhood Dreams]]'' (also known as ''The Last Lecture'') |
||
* 2008: [[Candye Kane]],<ref>[http://www.candyekane.com/cancer.html candyekane.com/cancer.html] |
* 2008: [[Candye Kane]],<ref>[http://www.candyekane.com/cancer.html candyekane.com/cancer.html] Update: 4/25/08 ...one week since I had the whipple procedure...</ref> singer and ex-[[pornographic actress]] |
||
==Nomenclature== |
==Nomenclature== |
||
| Line 75: | Line 75: | ||
==References== |
==References== |
||
{{ |
{{Reflist|2}} |
||
==External links== |
==External links== |
||
Revision as of 01:22, 3 March 2010
 | This article needs additional citations for verification. (March 2010) |
| Pancreaticoduodenectomy | |
|---|---|
| ICD-9-CM | 52.7 |
| MeSH | D016577 |
A pancreaticoduodenectomy, pancreatoduodenectomy,[1] Whipple procedure, or Kausch-Whipple procedure, is a major surgical operation involving the pancreas, duodenum, and other organs. This operation is performed to treat cancerous tumours on the head of the pancreas, malignant tumors involving common bile duct or duodenum near the pancreas.
History
This procedure was originally described by Alessandro Codivilla, an Italian surgeon, in 1898. The first resection for a periampullary cancer was performed by the German surgeon Walther Kausch in 1909 and described by Kausch in 1912.
It is often called the Whipple procedure, after the American surgeon Allen Whipple who devised a perfected version of the surgery in 1935[2] and subsequently came up with multiple refinements to his technique.
Anatomy involving the procedure
The basic concept behind the pancreaticoduodenectomy is that the head of the pancreas and the duodenum share the same arterial blood supply. These arteries run through the head of the pancreas, so that both organs must be removed. If only the head of the pancreas were removed it would compromise blood flow to the duodenum.
The most common technique of a pancreaticoduodenectomy consists of the en bloc removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.
Pancreaticoduodenectomy in modern medicine
The Whipple procedure today is very similar to Whipple's original procedure. It consists of removal of the distal half of the stomach (antrectomy), the gall bladder (cholecystectomy), the distal portion of the common bile duct (choledochectomy), the head of the pancreas, duodenum, proximal jejunum, and regional lymph nodes. Reconstruction consists of attaching the pancreas to the jejunum (pancreaticojejunostomy) and attaching the common bile duct to the jejunum (choledochojejunostomy) to allow digestive juices and bile respectively to flow into the gastrointestinal tract and attaching the stomach to the jejunum (gastrojejunostomy) to allow food to pass through.
Originally performed in a two-step process, Whipple refined his technique in 1940 into a one-step operation. Using modern operating techniques, mortality from a Whipple procedure is around five percent in the United States (less than two percent in high-volume academic centers).[3]
Pancreaticoduodenectomy versus total pancreatectomy
Some authors advocate the removal of the whole pancreas (total pancreatectomy) instead of just the head.[citation needed] However, clinical trials have failed to demonstrate significant survival benefits, mostly because patients who submit to this operation tend to develop a particularly severe form of diabetes called brittle diabetes. Sometimes the pancreaticojejunostomy may not hold properly after the completion of the operation and infection may spread inside the patient. This may lead to another operation shortly thereafter in which the remainder of the pancreas (and sometimes the spleen) is removed to prevent further spread of infection and possible morbidity.
Pylorus-sparing pancreaticoduodenectomy
More recently, the pylorus-sparing pancreaticoduodenectomy (also known as Traverso-Longmire procedure/PPPD) is growing increasingly popular, especially among European surgeons. The main advantage of this technique is that the pylorus, and thus normal gastric emptying, is preserved.[4] However, some doubts remain on whether it is an adequate operation from an oncological point of view. In practice, it shows similar long-term survival as a Whipple's (pancreaticoduodenectomy + hemigastrectomy), but patients benefit from improved recovery of weight after a PPPD, so this should be performed when the tumour does not involve the stomach and the lymph nodes along the gastric curvatures are not enlarged.[5]
Another controversial point is whether patients benefit from retroperitoneal lymphadenectomy.
Morbidity and mortality
Pancreaticoduodenectomy is considered, by any standard, a major surgical procedure.
Many studies have shown that hospitals where a given operation is performed more often will have better overall results, and especially so in the case of more complex procedures, such as pancreaticoduodenectomy. A frequently cited study published in The New England Journal of Medicine found operative mortality rates to be four times higher (16.3 percent vs. 3.8 percent) at low-volume (averaging less than one pancreaticoduodenectomy per year) hospitals than at high-volume (16 or more per year) hospitals. Even at high-volume hospitals, morbidity has been found to vary by a factor of almost four depending on the number times the surgeon has previously performed the procedure.[6]
One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.[7]
List of notable people who have had this surgery
- 2001: Chris Rea,[citation needed] singer-songwriter
- 2004: Steve Jobs,[8] co-founder of Apple Inc.
- 2007: Randy Pausch,[6] originator of the inspirational Really Achieving Your Childhood Dreams (also known as The Last Lecture)
- 2008: Candye Kane,[9] singer and ex-pornographic actress
Nomenclature
Fingerhut et al. argue that while the terms pancreatoduodenectomy and pancreaticoduodenectomy are often used interchangeably in the medical literature, scrutinizing their etymology yields different definitions for the two terms.[1] As a result, the authors prefer pancreatoduodenectomy over pancreaticoduodenectomy for the name of this procedure.[1]
References
- ^ a b c [clarification needed]Fingerhut, A.; Vassiliu, P.; Dervenis, C.; Alexakis, N.; Leandros, E. (2007). "What Is in a Word: Pancreatoduodenectomy or Pancreaticoduodenectomy?". Surgery. 142 (3): 428–9. doi:10.1016/j.surg.2007.06.002. PMID 17723902.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ synd/3492 at Who Named It?
- ^ [dead link]Public Information Site | MUSC Digestive Disease Center
- ^ Testini, M.; Regina, G.; Todisco, C.; Verzillo, F.; Di Venere, B.; Nacchiero, M. (1998). "An Unusual Complication Resulting from Surgical Treatment of Periampullary Tumours". Panminerva Med. 40 (3): 219–22. PMID 9785921.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Michalski, C.W. (2007). "Surgery Insight: Surgical Management of Pancreatic Ccancer". Nature Clinical Practice Oncology. 4 (9): 526–535. doi:10.1038/ncponc0925.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b "The Whipple Procedure" Pri-Med Patient Education Center, Harvard Health Publications
- ^ Syin, D.; Woreta, T.; Chang, D.C.; Cameron, J.L.; Pronovost, P.J., Makary, M.A. (2007). "Publication Bias in Surgery: Implications for Informed Consent". Journal of Surgical Research. 143 (1): 88–93. doi:10.1016/j.jss.2007.03.035. PMID 17950077.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Peter Elkind, Peter; Burke, Doris (March 5, 2008). "The Trouble with Steve Jobs — Jobs Likes To Make His Own Rules, Whether the Topic Is Computers, Stock Options, or Even Pancreatic Cancer. The Same Traits That Make Him a Great CEO Drive Him To Put His Company, and His Investors, at Risk." (see page four of article). Fortune (via CNNMoney.com). Accessed March 2, 2010.
- ^ candyekane.com/cancer.html Update: 4/25/08 ...one week since I had the whipple procedure...