Complications of Whipple Procedure
The Whipple procedure is associated with an operative mortality of 2 to 5% even when performed by the most experienced surgeons. The risk of operative mortality and morbidity has been found to be higher in hospitals where the procedure is performed less frequently (less that 1 surgery per year) compared to those hospitals performing the procedure frequently (16 or more surgeries per year).
Immediate complications following surgery include leakage from the new attachments (anastomotic leak) especially the leakage of pancreatic secretions, delayed emptying of the contents of the stomach, post operative infections and an abdominal abscess. A pancreatic fistula is common and can develop in as many as 20% of the patients undergoing Whipple procedure but biliary fistulas are much less common.
Almost about 40% of the patients having undergone the procedure experience delayed gastric emptying. It usually improves with time, but may take several weeks to several months in some patients. Patients can sometimes have troubling diarrhea, which may take 2 or 3 months to improve.
Malabsorption and steatorrhea may arise due to pancreatic enzyme deficiency or due to an obstruction in the newly made pancreaticojejunostomy which prevents the release of pancreatic enzymes into the gastrointestinal tract. Treatment with pancreatic digestive enzymes can improve this complication.
Diabetes usually does not arise following the Whipple procedure, despite removing a large portion of the pancreas.
Whipple Surgery Recovery Period
Patients usually stay in hospital for a week after the procedure followed by a slow recovery at home. The recovery period is often painful and associated with problems related to feeding. The pain usually needs use of analgesics.
Feeding is usually done in very small quantities and is confined to easily digestible food. Supplements with pancreatic enzymes may help digestion. Fat containing foods should be introduced only slowly and the pancreatic enzyme supplementation may be required for fat digestion.
The recovery of the digestive tract usually takes two to three months. The pylorus-preserving modification Whipple procedure which keeps the stomach intact reduces the recovery time and allows for early restoration of the gastrointestinal functions.
Prognosis Following Whipple Surgery
Cancer of pancreas has a relatively poor prognosis. The Whipple procedure or the modified procedures often only prolong the survival, and improve the quality of life. The five-year survival rate following the Whipple procedure is about 10 to20%. The ten-year survival rate however is very poor.
The most important factor that affects prognosis after the Whipple procedure is the absence of tumor at the resected margins. A tumor-free margin for the resected tumor is associated with about 25% five-year survival rates while presence of tumor on the resected margin lowers the five-year survival rates to less than 10%.
Lymph node status is an major factor affecting survival following the procedure. Lymph node negative patients have a five-year survival rate of about 36% while patients with positive lymph nodes have only 14%. Tumor size is another factor affecting prognosis.