# Whipple procedure (pancreaticoduodenectomy)

Source: https://onco.cc/terms/whipple/  
OnCo record `whipple` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The big operation for cancers of the head of the pancreas: the surgeon removes the pancreatic head, the duodenum, the gallbladder and part of the bile duct, then reconnects everything.

## Summary

Named after Allen Whipple (1935), it is the only curative option for pancreatic head, distal bile duct and ampullary cancers, and is offered only when imaging shows the tumour can be fully removed (resectable or borderline resectable after neoadjuvant therapy). It takes 5-8 hours, carries 2-4% mortality and 30-40% major complication rates (pancreatic fistula, delayed gastric emptying), and most patients need enzyme supplements afterwards. Distal pancreatectomy removes the tail instead. Neoadjuvant chemotherapy (FOLFIRINOX) and RAS inhibitors are increasing the share of patients who reach an R0 resection.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: Whipple; pancreatoduodenectomy; pancreatic resection

## Notes

- The 1935 Annals of Surgery paper by Whipple, Parsons and Mullins described the two-stage operation for carcinoma of the ampulla of Vater; the one-stage pancreatoduodenectomy that bears his name followed.
- NICE NG85 (1.8.3, 1.8.4) asks surgeons to consider pylorus-preserving resection when the tumour can be adequately removed and standard rather than extended lymphadenectomy for head-of-pancreas cancer; enzyme replacement is considered before and after the operation (1.6.2) and early enteral nutrition is preferred to parenteral (1.6.4).
- Living with it: Pancreatic Cancer UK says the first 24 to 48 hours are in intensive care or high dependency, hospital is usually one to two weeks, and full recovery takes several months to a year. The stomach may not empty normally for the first days (the ISGPS calls this delayed gastric emptying) and some people are fed through a tube until it does; eating starts with drinks and soft food, in smaller portions.
- Longer term: most people need pancreatic enzyme capsules with food, some develop diabetes, blood-thinning injections continue for about four weeks at home, driving waits a few weeks and work often takes at least three months. Report a hot, painful, leaking wound, sudden worse pain or a high temperature straight away.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Pancreaticoduodenectomy
- Wikipedia: https://en.wikipedia.org/wiki/Pancreaticoduodenectomy
- Whipple, Parsons and Mullins, Ann Surg 1935: treatment of carcinoma of the ampulla of Vater: https://doi.org/10.1097/00000658-193510000-00023
- NICE NG85: pancreatic cancer in adults (diagnosis 1.1, staging 1.3, nutrition 1.6, biliary obstruction 1.7, resectable disease 1.8): https://www.nice.org.uk/guidance/ng85/chapter/Recommendations
- Pancreatic Cancer UK: after your operation: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/after-your-surgery/
- Pancreatic Cancer UK: side effects of surgery: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/side-effects-of-surgery/
- Pancreatic Cancer UK: going home from hospital after surgery: https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/surgery-for-pancreatic-cancer/recovering-from-surgery/
- Macmillan: surgery for pancreatic cancer, before and after: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-for-pancreatic-cancer
- Wente et al., delayed gastric emptying after pancreatic surgery, the ISGPS definition (Surgery 2007): https://doi.org/10.1016/j.surg.2007.05.005

## Connected records

- terms: [Centralisation and high-volume centres](https://onco.cc/terms/centralisation/), [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [Eating after a Whipple operation: slow stomach emptying, dumping and bowel changes](https://onco.cc/terms/eating-after-whipple/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it](https://onco.cc/terms/pancreatic-enzyme-replacement/), [R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting](https://onco.cc/terms/r0-r1-margin-pancreatic/), [Resectable, borderline resectable and unresectable](https://onco.cc/terms/resectability/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Surgical morbidity and postoperative complications](https://onco.cc/terms/surgical-morbidity/), [Type 3c diabetes with pancreatic cancer](https://onco.cc/terms/type-3c-diabetes-pancreatic-cancer/), [Vascular resection in pancreatic cancer surgery (portal and superior mesenteric vein resection; arterial resection)](https://onco.cc/terms/vascular-resection-pancreatic/)
- cancers: [Adenosquamous carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/), [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Borderline resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/borderline-resectable-pdac/), [Colloid (mucinous non-cystic) carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-colloid-carcinoma/), [Extrahepatic cholangiocarcinoma (perihilar and distal)](https://onco.cc/cancers/extrahepatic-cholangiocarcinoma/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma)](https://onco.cc/cancers/ipmn-associated-carcinoma/), [Localised small bowel adenocarcinoma (stage I to III, resected)](https://onco.cc/cancers/localised-small-bowel-adenocarcinoma/), [Locally advanced unresectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/locally-advanced-pdac/), [Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma](https://onco.cc/cancers/msi-high-pdac/), [Pancreatic acinar cell carcinoma](https://onco.cc/cancers/pancreatic-acinar-cell-carcinoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Pancreatic neuroendocrine tumours](https://onco.cc/cancers/pancreatic-net/), [Pancreatoblastoma](https://onco.cc/cancers/pancreatoblastoma/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/), [Small intestine cancer (small bowel adenocarcinoma)](https://onco.cc/cancers/small-bowel/), [Solid pseudopapillary neoplasm of the pancreas](https://onco.cc/cancers/solid-pseudopapillary-neoplasm/), [Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells](https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- institutions: [Aberdeen Royal Infirmary](https://onco.cc/institutions/aberdeen-royal-infirmary/), [Castle Hill Hospital, Hull (Queen's Centre)](https://onco.cc/institutions/hull-castle-hill/), [Ninewells Hospital, Dundee](https://onco.cc/institutions/ninewells-dundee/), [Raigmore Hospital, Inverness](https://onco.cc/institutions/raigmore-inverness/), [Royal Blackburn Hospital (East Lancashire HPB MDT)](https://onco.cc/institutions/royal-blackburn-elht/), [Royal Stoke University Hospital](https://onco.cc/institutions/royal-stoke-uhnm/), [Royal Surrey County Hospital, Guildford](https://onco.cc/institutions/royal-surrey-guildford/), [University Hospital Coventry](https://onco.cc/institutions/uhcw-coventry/)
- key papers: [Preservation of the pylorus in pancreaticoduodenectomy](https://onco.cc/key-papers/paper-traverso-longmire-pylorus-preservation-pancreaticoduodenectomy-sgo-1978/), [Treatment of carcinoma of the ampulla of Vater](https://onco.cc/key-papers/paper-whipple-carcinoma-ampulla-of-vater-ann-surg-1935/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival](https://onco.cc/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/)

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