Evolution of the Whipple procedure at the Massachusetts General Hospital

Abstract

Background Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). Methods We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. Results The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). Conclusion The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.

Pylorus preservation pancreatectomy or not

“…However, opponents of pyloruspreserving PD have questioned its oncological adequacy so that the preservation of the pylorus in cancer patients has been a controversial issue for years. In addition, an increased incidence of DGE was observed in patients undergoing pylorus-preserving PD (19)(20)(21)(22). However, depending on trials designs and definitions of outcomes, frequencies of DGE varied considerably between the studies, ranging between 5% and 57% (23).…”

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

“…In the model, the proportion of patients with cysts who underwent subsequent pancreatic surgery (five of 84 patients, 6%) in a singlearm multimodal screening trial was used as a proxy for the proportion of highrisk cysts ( Cancer states common to both pathways were subdivided according to stage (historic Surveillance, Epidemiology, and End Results stages: local, regional, distant, and unstaged) and as to whether the cancer had been detected (Fig 1). Causes of death included age-specific allcause mortality (48), pancreatic surgery (42)(43)(44)(45)(46)(47), and PDAC (3). Patients in all states were subject to all-cause mortality and, upon entering a cancer state, were also subject to a PDAC-specific mortality rate, which was dependent on stage and detection status.…”

“…Fixed inputs included rates of all-cause mortality (age and sex specific) (48), surgical mortality (42)(43)(44)(45)(46)(47), and relative survival according to stage for detected cancers (3) ( Tables 2, 3). Most transition probabilities in the model, however, addressed "unobservable" events (eg, progression from undetected regional to undetected distant PDAC) (Fig 1), a typical feature of natural history models (50).…”

Duodenopancreatectomía Completamente Laparoscópica en El Manejo Del Cáncer Periampular: Estudio De Un Caso

“…La mortalidad postoperatoria mejoró notoriamente durante las últimas décadas de 45% a 5%, sin embargo aún se asocia a alta morbilidad (41,2%) y frecuentes estadías hospitalarias prolongadas [1][2][3]9 .…”