Once you are told there is cancer in the head of the pancreas, there is one word that almost always comes out of the doctor's mouth: the "Whipple" procedure. Its formal name is pancreaticoduodenectomy, but because that is hard to pronounce, everyone simply calls it the Whipple. From the name alone, it is easy to assume that only one part of the pancreas is removed, but that is not the case. The head of the pancreas is attached to the duodenum, the bile duct, and the gallbladder almost like a single mass, so removing the cancer-bearing head means clearing out the surrounding organs as well. That is why it is counted as a major operation.
Looking at exactly what is removed, it includes the head of the pancreas, the entire duodenum, the gallbladder, the lower part of the bile duct, and a portion of the stomach or the stomach outlet. Seen only this far, you might think, "How can anyone live after removing so much?" but the key lies in reconnecting everything afterward. The remaining pancreas is joined to the small intestine, the bile duct is newly attached to the small intestine, and the stomach is reconnected to the small intestine as well. It amounts to laying out three new pathways inside one person's abdomen, so the operation takes a long time and the surgical team has to concentrate hard. One acquaintance laughed in the recovery room after surgery, saying "the map of my belly has completely changed" - and he was not wrong.
In many cases, what wears a person out is not the surgery itself but the recovery process. The complication most commonly watched for is pancreatic fluid leaking from where the pancreas was joined to the small intestine (a pancreatic fistula). For this reason, a thin drainage tube is left in the abdomen after surgery, and its color and volume are checked for several days. At first this tube feels cumbersome and stifling, but it helps to think of it as a safety device that catches a leak early, which puts the mind at ease. Sometimes the stomach's emptying function slows down for a while and food does not pass through well, but this usually resolves slowly with time. Not rushing is, in fact, the cure.
Once you are discharged and back home, that is when the real adjustment begins. Because part of the pancreas is gone, there is a shortage of digestive enzymes, so eating fatty foods causes diarrhea or a bloated, heavy feeling. To help with this, you end up taking enzyme supplements with every meal, and people say it shows immediately if you skip the medication. Rather than eating a lot at once, it is more comfortable to divide food into five or six small portions a day; at first you start with porridge or soft foods and increase gradually while watching how your body responds. If the part of the pancreas that makes insulin is also affected, blood sugar can swing and some people begin managing newly developed diabetes. Since it varies from person to person, recording the signals your body sends is a great help at your appointments.
The recovery period is usually counted in weeks, and at most a few months. At first, even walking one lap around the house leaves you out of breath, but that short walk wakes up bowel movement and reduces complications such as pneumonia. The key is to increase the amount you walk little by little, without overdoing it. Then one day comes a moment when you think, "Today is a little less hard." Noticing that small change becomes the strength to get through recovery.
This article is general information written to help you understand pancreatic cancer and the Whipple procedure. The extent of what is removed, the speed of recovery, and medication use differ from person to person and from hospital to hospital, so please be sure to discuss the details with your own medical team.