What is pancreaticoduodenectomy?
During the operation, the following are removed:
- the head of the pancreas
- the duodenum
- the gallbladder
- the distal part of the common bile duct
- the regional lymph nodes
In most cases, the distal part of the stomach is also removed (the classic Whipple procedure). When indicated, a *pylorus-preserving pancreaticoduodenectomy (PPPD)* may be performed, which preserves the pylorus.
After the resection stage, the digestive tract is reconstructed by creating a pancreaticojejunostomy, a hepaticojejunostomy, and a gastrojejunostomy or duodenojejunostomy.
Our approach
At MSI, tumors of the pancreaticoduodenal region are treated by a multidisciplinary team in line with modern guidelines from the *NCCN, ESMO, and ISGPS (International Study Group of Pancreatic Surgery)*.
Before surgery, every patient undergoes full staging of the disease, including multiphase computed tomography or MRI, laboratory tests, tumor markers, and, when indicated, endoscopic ultrasound or biopsy.
We carefully assess the resectability of the tumor, its relation to the major blood vessels, and the need for preoperative systemic therapy.
*When technically feasible and oncologically safe, we aim to perform pancreaticoduodenectomy laparoscopically.* The minimally invasive approach reduces surgical trauma and postoperative pain, speeds up recovery, and shortens the hospital stay without compromising the radicality of treatment.
We pay special attention to a standardized reconstruction technique, prevention of postoperative complications, and fast recovery under the *ERAS (Enhanced Recovery After Surgery)* program.
When is surgery needed?
Pancreaticoduodenectomy is performed for:
- cancer of the head of the pancreas
- tumors of the major duodenal papilla (ampullary cancer)
- cancer of the distal common bile duct
- duodenal cancer
- neuroendocrine tumors of the head of the pancreas
- certain precancerous and benign lesions (IPMN, MCN) when indicated
Indications for surgery
Surgery is recommended for:
- resectable tumors of the pancreaticoduodenal region
- borderline resectable tumors after neoadjuvant therapy
- precancerous lesions with a high risk of malignant transformation
- no distant metastases
How is the operation performed?
The procedure is performed under general anesthesia.
After the pancreaticoduodenal complex is mobilized, the resection stage is performed, removing the affected organs together with a regional lymph node dissection. The digestive tract is then reconstructed by creating a pancreaticojejunostomy, a hepaticojejunostomy, and a gastrojejunostomy (or a duodenojejunostomy in the pylorus-preserving operation).
The removed specimen is sent for full histopathological examination to determine the final stage of the disease.
Advantages of laparoscopic surgery
- The operation is performed laparoscopically whenever possible
- Less surgical trauma
- Less postoperative pain
- Faster return to physical activity
- Lower risk of wound complications
- Shorter hospital stay
- Oncological radicality in line with international standards
Recovery after surgery
After surgery, patients recover in stages under the *ERAS* program. Eating is resumed gradually, and pancreatic function, blood glucose, and the condition of the anastomoses are monitored.
If necessary, enzyme replacement therapy is prescribed, and further treatment is decided by the multidisciplinary tumor board once the histopathology results are available.
Our advantages
- Specialization in surgery of the pancreas and pancreaticoduodenal region
- A commitment to laparoscopic surgery when it is safe and oncologically justified
- Use of modern reconstruction techniques after resection
- Multidisciplinary treatment planning
- Adherence to NCCN, ESMO, and ISGPS international guidelines
- Enhanced recovery program (ERAS)
- Comprehensive patient support at every stage of treatment
Frequently Asked Questions
For resectable tumors, yes. It is the main radical treatment and is often combined with modern systemic anticancer therapy.
Pancreaticoduodenectomy involves removing several organs and creating three complex reconstructive anastomoses, which makes it one of the most technically demanding operations in abdominal surgery.
Yes. When indicated and oncologically safe, we aim to perform pancreaticoduodenectomy laparoscopically. The final decision depends on the characteristics of the tumor and the individual clinical situation.
Some patients need enzyme replacement therapy after surgery to improve digestion. This is decided individually during postoperative follow-up.
Most patients with pancreatic cancer are recommended adjuvant chemotherapy after radical surgery. The final treatment plan is determined once the histopathology results are available and discussed by the multidisciplinary tumor board.