A 62-year-old man complains of experiencing intermittent, but increasing abdominal pain, and has had a 9 kg weight loss in the last month. On physical examination, he seems to be slightly jaundiced. Alkaline phosphatase and bilirubin are increased. CT scan demonstrates a mass in the head of the pancreas. Which of the following surgical methods is used most often to treat patients with small tumors of the head of the pancreas with no evidence of metastasis?
Whipple procedure, also known as a pancreaticoduodenectomy. In this surgical procedure, the duodenum, proximal pancreas, gallbladder, and sometimes, the distal stomach are resected. The remaining pancreas, biliary tree, and stomach are then reattached to the small intestine. The Whipple procedure is only performed in the relatively small percentage of patients who may have resectable disease. Tumors of the tail of the pancreas might, in theory, be more easily resected, but this area tends to not produce any signs or symptoms until late in the disease, after metastasis has occurred. Pancreatic cancers that are not resectable can be treated with chemotherapy and radiation therapy. Immunotherapy using a vaccine based on the patient's own cancer cells is also being tried experimentally, and shows promise. An impoant thing to remember when treating these patients (and other poor prognosis patients) is that long-term survivors have occurred, and that even if death eventually intervenes, a survival of several years may be very much wohwhile to both the patient and his family (paicularly if young children are indirectly involved). The Billroth I and II procedures are used to treat gastric carcinomas and intractable peptic ulcers of the duodenum and stomach. While you could argue that the gastric resection pa of the Whipple procedure resembles a Billroth II operation, you should pick the Whipple procedure if both answers are available, because it is much more specific for pancreatic carcinoma. The Roux-en-Y gastric bypass is used to treat obesity by reducing the effective stomach volume.
Billroth l procedure
Billroth ll procedure
Roux-en-Y gastric bypass
Whipple procedure