NEW WAYS TO TREAT PANCREATIC CANCER WITH SURGERY: A LOOK AT THE RESULTS OF THE WHIPPLE PROCEDURE

Abstract

Background: Pancreatic cancer still represents a devastatingly aggressive malignancy with dismal survival. Although the diagnosis and detection of ampullary neoplasms have substantially improved, surgical resection, specifically pancreaticoduodenectomy (Whipple surgery), remains the mainstay of curative treatment. In the last decades, new methods and perioperative management have achieved better results in complications related to this demanding procedure.

Objective

 This study aimed to analyse the results of Whipple's operation in the treatment of pancreatic cancer, considering new developments and their influence on postoperative recovery, survival, and quality of life.

Method

 A retrospective cohort study was conducted from October 2023 to September 2024 in Mayo Hospital, Lahore. My experiment's interesting group was composed of 50 patients with histologically submitted pancreatic cancer and modified Whipple surgery. Demographics, staging, surgical approach utilised, perioperative management pathways used, postoperative complications, duration of hospital stay and survival were compiled and analysed. Its analysis compared new minimally invasive surgery approaches, ERAS (enhanced recovery after surgery) protocols and intraoperative imaging against patients’ outcomes. SPSS performed a statistical test, and p<0.05 was considered statistically significant.

Results

Among the 50 patients in whom SOCE was assessed, 60% were male with a mean age of 58. At least 40% were treated with a minimally invasive approach: laparoscopic or robotic-assisted Whipple. The mean duration of the operation was 360 ± 45 minutes, and the median blood loss in the minimally invasive group was much lower (250 mL versus 450 mL; p=0.02). Postoperative complications were reported in 30% of the patients, with pancreatic fistula being the most frequent (10%). ERAS protocols shortened the length of hospital stay (8.5 days vs 12 days, p=0.01) and the time to return to baseline activities.

The 1-year survival rate was 72%, and the survival curves of minimally invasive techniques were better than those of traditional open ones. Patients perceived quality of life after surgery as superior, particularly regarding physical functioning and pain control.

Conclusions

Surgical management of pancreatic cancer, especially utilisation of minimally invasive surgery and ERAS protocol, has largely improved the outcome in Whipple's procedure. These lead to less operating time, reduced blood loss, shorter hospital stays, and improved quality of life for patients. Continued emphasis on surgical training

Perioperative care should be optimised to continue enhancing survival and the recovery of patients with PC.

Keywords:

Pancreatic cancer, Whipple procedure, pancreaticoduodenectomy, minimally invasive surgery, enhanced recovery after surgery, post-operative outcomes, surgical innovations.