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Thread: Prognosis after whipple procedure

  1. #1
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    Prognosis after whipple procedure

    I apologize if this subject has been discussed before-I have been reading on this forum and did not see it discussed too much so I am asking this question.
    My father in law was just diagnosed with stage 2 pancreatic cancer and just was in the hospital for a shunt due to jaundice. He also had a laproscopy and they felt he was suitable for surgery. The surgeon that he wants will be away for a few weeks so the surgery is scheduled for 7/19/07. They tell him he can wait, but my husband and I are concerned that waiting the 3 weeks may not be the right thing. There is another surgeon who can operate about 9 days sooner. Should we have the surgery moved up or waiting the 9 days really wont matter that much? It seems to be causing changes in his body almost daily so my inclination is to move it up but my father in law only wants this one particular surgeon who has a good reputation with the Whipple. One of his physicians told my husband that sometimes this procedure is done as corrective and sometimes it is just palliative and in my father in laws case, he felt it was pallliative. So, do you put someone through this 8 hour surgery with complications and a long recovery time? I know it is someone's life and possibly his only chance, but I read that the mortality rate is high even after the Whipple-is this fair to do to the patient and their family if there is only a few more months of extended life? We are very confused and most likely will do the surgery and wait until the 19th but was just wondering if anyone has an opinion about doing this procedure at all or moving it up. Thanks for any advice you could offer and I wish the best to all those who are suffering from this disease.

  2. #2
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    Post-Whipple reality

    Let me give you a brief statement of my background before directly answering your question. My Whipple procedure was on October 21, 2004, after my initial diagnosis with what they thought was stage I pancreatic adenocarcinoma. I have passed two and a half years since then, and while I am now in stage IV, I am still alive. Pancreatic cancer is almost always a death sentence, and the primary question is how long the patient has to live, and what are the circumstances of that remaining life. My life is testimony to the fact that some of us last quite a while before the cancer gets us, and so the Whipple procedure may be a reasonable thing to do.

    The delay itself would not necessarily worry me. The difference of nine days is not material. The question with the Whipple procedure is how experienced the surgeon is - i.e. how often does she/he do this most complicated surgery? In my case, my surgeon was Dr. Selwyn Vickers, who had performed about 40 of them per year for the last several years before mine. The one thing you do not want is someone who is not seriously experienced, as the surgery is so massive and invasive that it does not take much of a wrong step to kill the patient all by itself. Go with the doctor with experience.

    As to the question of life after the surgery, I will say that it is, for me, much better than it was before the surgery. The shunt / stent is a necessary but insufficient method for opening up the bile duct. It helps get the pressure off, and to get the biliruben level down in preparation for surgery, but it is just not enough to do the job by itself. If there is going to be a six month prognosis at all, the surgery is probably necessary. It took about two months to get over mine enough to be allowed to proceed with radiation treatments, and by day fourteen after the surgery the positive change was dramatic.

    Now there are no guarantees whatsoever in all of this. I had a friend who had the same surgery with the same team six months after mine, and she never made it out of the hospital. Seven weeks later she was gone. I was hospitalized in the same ward at the time, and it was devestating to everyone to see this.

    In short, I cannot make decisions for you. The question of whether a Whipple procedure is ever curative is not one I can answer. Pancreatic cancer is so very pernicious that I have seen nearly no one ever make it to the five year point. Nevertheless, in my case it was a necessary step for me to live this long, regardless of what may happen tomorrow. What are a few more months of life worth? Mine have been priceless.

    You might want to look over my pancreatic cancer blog which is listed below. You will see tat I have had a real roller-coaster ride.

    Best Regards,

    Marty
    -------------------------------------------------
    whipple procedure, Oct. 21, 2004
    28 days of radiation
    56 days of Chemo using Xeloda
    diagnosed as progressive recurrent pancreatic adenocarcinoma (Stage IV) Jun. 20, 2006
    was treated with gemcitabine, oxaliplatin, and tarceva, which all failed.
    Cancer blog: http://diehlmartin.com/cancer.html

  3. #3
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    prognosis after whipple

    Thanks for your quick and heartfelt reply. My father in law is very confident in his surgeon. Dr Joe Levi of University of Miami Jackson Memorial Hospital supposedly does close to 80-90 Whipples/year. Someone who is at Sloan Kettering told us to go with him although the other surgeon who is available is also good and trained at Sloan Kettering. It is just that in the 2 weeks since he has been diagnosed I have seen him deteriorate-the jaundice, discomfort, weakness etc. seems to have increased so dramatically that I didn't want to wait if we can have the surgery done sooner. My father in law truly believes he will have this surgery and recover and live on another 15-20 years because his own mother lived to be 100. In the 35 years I have known him, he has never been in the hospital or been treated for anything serious. I don't think he understands the realism of this disease and while my husband does, he doesn't want to accept it and chooses to believe like his dad. I have researched the Whipple and understand it to be a very extreme surgery and didn't know if it was worth going through but I am sure it is if it extends ones life some. thans

  4. #4
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    Mississippi
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    I just saw this post and have copied my first post on the Whipple procedure below. You can read the entire thread later on this page. I am about 14 months behind "Marty" in recovery but am still going ok at this point. Another Lady that I met at Ochsner Hosptial had the Whipple the same day as I did by the same Doctor and she died in Sptember 2006. She had the same cancer as I did but she just never really recovered like I have. Each case is different. Your body will not be the same as before the Whipple but I am still here. I picked the earliest possible date for my Whipple (Cancer discovered on 12-3-2005- Whipple on 12-16-2005) but each person has to decide what is best for them. I feel that without the Whipple I would not be here today. I Trust in the Lord.

    Ken




    "Hi I just found this forum. I am a 69 year old male that was diagnosed with "Carcinoma of Ampulla of Vater" in early December 2005. Four Doctor's from the local hospital all told me Whipple surgery was a no-brainier in my situation so I went for it. Surgery was set up with Dr John Bolton at Ochsner Hospital in New Orleans for 12-16-05. I was released from the hospital on 12-24-05. During the Whipple Dr Bolton took out the usual parts and I had Stage 2 cancer that had not spread so no Chemo in my case. I had problems with eating and the recovery for two months was not good (hospitalized twice) but then it completely turned around and my weight started to increase and I feel fine. I have some stomach stress from time to time but have found that by taking GasX it helped. In August and September I had my first checkup which included a Cat Scan, MRCP and a Liver Biopsy along with blood work. All the test were normal except for evaluated ALK Phos which is thought to be drug (meds) induced.

    I just wanted to share that there is life after cancer and as for me I give all the glory to God for healing me. Life does exist after the Whipple procedure.

    I have read lots of the stories on this forum and my heart goes out to each of you. Don't give up hope and trust in God who is with you on this journey as he has been with me.

    Ken"

 
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