Whipple Surgery – Open and Minimally Invasive Options

Whipple Surgery – Open and Minimally Invasive Options


[MUSIC] Pancreatic cancer is as most people know a
very aggressive disease. It has a propensity for metastasizing
early. It can grow into numerous vital structures
which are very, in very close proximity to the
pancreas. Unfortunately only about 20% of patients
are actually a candidate, for surgery. And the ultimate goal of the operation, is
to remove the tumor as best as we can, leaving no
tumor behind. And for tumors at the head of the
pancreas, that’s done through what’s called a whipple
operation, or a pancreaticoduodenectomy. It’s a pretty complex operation, lasts
anywhere from four and a half to six hours with a, sort of standard
pancreatic cancer. And is a very involved technique that in, the first half of the operation, the tumor
is removed and then the second half of the
operation the GI tract is reconstructed for what’s
left behind. There’s two general options to perform
this operation. Far and away, the most common option, is
to do it through an open approach, or through a
standard incision. And the operation has been done that way
for many years. And that approach was essentially,
perfected by Dr. Cameron, and is considered to be the standard of
care. More recently, there’s minimally invasive
approaches where essentially the same operation is
done, but it’s done using specialized
instruments and smaller incisions in the abdominal
wall. And if you were to ask me a few years ago
if this really had a place in cancer surgery,
I would have been skeptical. But with the current evidence coming out
and the skill level, I some of our surgeons, becoming convinced, that there’s a subset
of patients, who actually may benefit from this app,
approach. And it may have some theoretical benefits,
when it comes to cancer surgery, and that’s a quicker
time to chemotherapy. However, the key is really the proper
selection of patients. The ultimate goal of the operation is to
remove the tumor. If that’s compromised by the laparoscopic
approach, then the benefit of having smaller incisions is really
outweighed by the compromise in the operation. And we’re very fortunate here at Johns
Hopkins that we have surgeons who can do both. And so every patient is selected for what
we think is the best option for them. In patients who have a favorable tumor and
we feel we will not compromise the operation through
laparoscopic surgery they will undergo a laparoscopic whipple or
pancreaticoduodenectomy. In those patients who have tumors which we
feel we may compromise margin or does not
appear to be technically feasible or safe, we will then
perform the open operation and give the best oncologic
result, through that approach. [MUSIC] [BLANK_AUDIO]


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