Pancreatic cancer - one of the most common types of cancer, has a fairly poor prognosis. At the time of diagnosis, often it turns out that already have a secondary tumor lesions afflicting other organs. This is because this type of cancer often grows long before cause any symptoms. Such patients are not performed an operation to remove the primary tumor.
Minimally invasive techniques used clinic Assuta, allow for treatment with minor traumatization of tissue in surgical intervention. To minimize blood loss is reduced, there is a rapid recovery of patients. You serve leading experts, surgeons, whose names are known all over the world. We offer:
- High level of comfort.
- Reasonable prices for services.
- Innovative equipment operating theater, intensive care units, recovery boxes.
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Surgery is recommended as a potentially curative measures, if the tumor is well localized in the pancreas borders. This type of treatment is discussed with your doctor to see how it is a viable option. surgery type is determined based on the location of the tumors. When the tumor is located in the head of pancreas or pancreatic duct in the hole, the Whipple operation is performed if the malignant process struck body or tail gland - surgery is performed, it is referred to as distal pancreatectomy (pakreatektomiya).
Assuta Hospital serves a large number of these types of operations. Surgeons team also includes highly gastroenterologists, specialists in genetics, nurses, et al., To provide the best and most complete medical care for patients.
Whipple surgery (another name pancreatoduodenal resection) was first described in 1930 by Allan Whipple. In the 60 years the mortality rate after it has been very high.
Today, it is absolutely safe surgery. In Israel tertiary care centers, which performed a large number of these procedures, the mortality rate is less than 4%. According to research, the achievement of good results is directly determined by the experience of the medical institution and directly surgeon experience.
What is the Whipple operation?
During this surgery removes the head of the pancreas, part of the bile duct, the gallbladder and the duodenum. In some cases, the resected portion of the stomach (pylorus). Thereafter, the remaining segment of the prostate, bile duct is connected to the intestines. on average, the procedure takes about six hours. After that, most patients remain in the hospital for one - two weeks.
Can be used minimally invasive or laparoscopic approach, the choice of location of the tumor affects its factor. This type of surgery is recommended when ampullar cancer. Laparoscopic procedure is performed through small incisions in the abdomen. The operation is performed with a special medical equipment. Conventional surgery requires cavity, a long incision, opening the abdominal cavity. Through minimally invasive approach reduces blood loss and risk of infection.
Surgeons - oncologists in Assuta will determine whether the patient is a candidate for laparoscopic surgery. They offer the best options to suit the individual needs of each patient.
When is the Whipple operation?
- Cancer of the pancreatic head.
- Cancer of the duodenum.
- Cholangiocarcinoma (a tumor of the biliary cells of the liver or bile moves).
- ampoule Cancer (the area where the bile and the pancreatic duct enter the duodenum).
Sometimes this type of surgery treated for disorders of benign nature - chronic pancreatitis, benign tumors of the prostate.
Only 20% of patients have the opportunity to conduct this surgery. These are mainly patients whose tumor process is in the head of the pancreas and has not spread to any nearby large blood vessels, liver, lungs, and so on. Conduct a thorough diagnosis before potential candidates are determined.
Some patients have a chance of laparoscopic surgery that reduces blood loss, shorter hospital stay, faster recovery and fewer complications.
Approximately 40% of patients the surgery may not be an option, as there are metastases. In rare cases, used for locally advanced tumors that have penetrated the surrounding areas - mesenteric vein or artery, or when the tumor has spread throughout the body or tail of the pancreas.
What are the results pancreatoduodenectomy?
Over the past 15 years in the Assuta had achieved excellent results after this operation, the mortality rate is less than 5%. Studies by American scientists show that the outcome of the operation depends on the experience of the hospital and the surgeon performing the surgery. At the clinics, home of the large volume of these procedures, the mortality rate is less than five percent. The surgical literature refers to the following figures: in hospitals that perform rarely this type of surgery, there is a much higher rate of complications, the mortality rate is 15-20%.
Do improve survival pancreatoduodenal resection?
Overall survival in pancreatic adenocarcinoma after this operation is about 20% for five years. If no metastases in the lymph nodes, the survival rate is 40%. Patients with this diagnosis, are being treated by chemotherapy, the survival rate is less than 5%.
Do I need further treatment after pancreatoduodenectomy?
After this operation, it is recommended chemotherapy and radiotherapy. Research scientists from Johns Hopkins University have shown that treatment with cytostatic agents and radiation after surgery for pancreatic adenocarcinoma increases survival by 10%.
We do not recommend further treatment for patients with benign tumors and neuroendocrine tumors.
What is the likelihood of diabetes after surgery Whipple?
In the process of the surgery removed the pancreas head - part of the body. gland tissue produce insulin needed to control blood sugar levels. Resection of the prostate leads to a decrease in insulin synthesis, there is a risk of developing diabetes.
Experience shows that in patients with abnormal glucose levels before surgery, there is a high likelihood of developing this disease. In patients with normal sugar content and lack of chronic pancreatitis there is a low risk of diabetes.
That can be eaten after pancreatoduodenectomy?
After the operation, there are no restrictions in the diet. Some patients may experience an intolerance very sweet foods, and may have to discontinue its use.
Change there life after surgery?
Several lifestyle changes after surgery Whipple, within limits. Most patients return to normal life.
During one study, American scientists performed an estimation of quality of life. People who have this operation to answer questions relating to the physical abilities, psychological problems, social issues, features, and disability. This survey was also conducted among a group of people healthy people and groups of people who have undergone laparoscopic removal of the gallbladder. The maximum possible number of points was 100%. The following results were obtained
People Whipple surgery
People after the removal of the gall bladder
Thus, these results show a slight change in lifestyle.
What complications are likely to occur immediately after surgery?
This type of surgery is a complex surgery with a high risk of complications if the surgeon performing it has limited experience. If the doctor has extensive experience in conducting this surgery, the incidence of complications is very low.
- Pancreatic fistula. After removal of the prostate tumor is connected to the intestines. The pancreas is a very soft body, and in some cases joint heals poorly. If this happens, there is leakage of pancreatic juice. Usually the surgeon during the operation locates the drainage catheter in the peritoneal cavity, with it eliminates any leakage. Almost all patients who develop this side effect, it runs independently. a second operation is needed in very rare cases.
- Gastroparesis (gastric paralysis). In the first 5-6 days of placing the dropper until the bowel recover work after surgery. Following the resumption of its functions will be to translate the doctor patient with intravenous feeding on a normal diet.
- In 25% of patients of gastric paralysis after surgery, this state can last from 4 to 6 weeks, has not yet completed the process of adapting to the changes, and the body starts to function normally. There are problems with food. Probably, there will be a need for enteral nutrition via a tube, which was placed by the surgeon during an operation in the intestine. Most of the patients of the stomach is reduced in four - six weeks after surgery.
What are the potential long-term complications after pancreatoduodenectomy?
- Malabsorption. The pancreas produces enzymes necessary for digestion process. When performed removing a portion of the body may be reduced synthesis of these enzymes. Patients complain of occurrence of diarrhea in the use of high-fat food. Prolonged treatment with preparations containing enzymes usually relieves.
- Changes in the diet. After this operation, the clinic Assuta is usually recommended to eat small portions, snacking between meals that will provide better absorption and minimizes the feeling of fullness.
- Weight loss. Patients typically lose from 5 to 10% of body weight after surgery compared to the body weight before illness. As a rule, the state quickly returned to normal, the majority of patients after the loss of a small amount of weight are able to maintain a normal weight.