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Medical Forum / Diseases and Disorders / Cancer / January 2006Whipple's procedure
has anybody been through a whiple's procedure for pancreas cancer .. if so how was it and what it life like afterwards Cheers john > has anybody been through a whiple's procedure for pancreas cancer .. if so > how was it and what it life like afterwards Hi John, My friend's neighbour's brother had it done about 6 years ago. (Canada) If I recall correctly, he lost some weight and had diabetic type issues, but was able to get on with his life, after he recovered from the surgery. Long-term, I don't know because the neighbour moved and we've lost track of her (and him, through her). He was in his 40's at the time. Is it about you? Here's a few web sites which give good information. US <http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas %20resection/whipple%20operation.html> (hope that works - it's a long url) UK http://www.cancerhelp.org.uk/help/default.asp?page=3124 has diagrams showing various surgeries. This one shows a before and after http://www.mayoclinic.org/pancreatic-cancer/whippleprocedure.html and says that "Patients leave the hospital in an average of 14 days." It is major surgery, but considering the option.... J Patients who's cancer is not too advanced do well. the surgeons can select who they think will be good candidates. It is major surgery, but I can't remember any patient in the Boston Area staying 14 days in the hospital. In a previous positions working for insurance company where you would get length of stay reports and I can't remember a stay over 7 days. I would suspect it is lower since now they are using the non invasive approach. From reading the 2 links below- I would go to a high volume center where they are familiar with the procedure. Best of Luck, Alex Here is a great link - that will answer most of your questions: http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas %20resection/whipple%20operation.html Importance of Hospital Volume in the Overall Management of Pancreatic Cancer. Annals of Surgery. 228(3):429-438, September 1998. Sosa, Julie Ann MD *+; Bowman, Helen M. MS ++; Gordon, Toby A. ScD *++; Bass, Eric B. MD, MPH ; Yeo, Charles J. MD *; Lillemoe, Keith D. MD *; Pitt, Henry A. MD *; Tielsch, James M. PhD [//]; Cameron, John L. MD > Patients who's cancer is not too advanced do well. the surgeons can select > who they think will be good candidates. It is major surgery, but I can't [quoted text clipped - 4 lines] > reading the 2 links below- I would go to a high volume center where they are > familiar with the procedure. Just FYI, he's in UK, so unless he's got lots of money or extra insurance, I wouldn't muck around too much getting too many opinions or travelling if it's adeno type pancreatic cancer. Unless he expects delays on referral in UK. Hopefully Pat will help you. http://www.cancer.org/docroot/<too long> http://tinyurl.com/86v6o American Cancer Society webpage Although the patient's history, physical examination, and imaging test results may strongly suggest cancer of the pancreas, the only way to be sure is by removing a small sample of tumor for examination under the microscope. A procedure to remove a tissue sample is called a biopsy. There are several types of biopsy procedures. The procedure used most often to diagnose cancer of the pancreas is called a fine needle aspiration (FNA) biopsy. For this test, a doctor can insert a thin needle through the skin and into the pancreas. The doctors use CT scanning images or endoscopic ultrasonography to view the position of the needle and make sure that it is in the tumor. Doctors can also biopsy the tumor by using the endoscopic ultrasound to place the needle directly through the wall of the duodenum into the tumor. In either case, small fragments of tissue can be removed through the needle for examination under the microscope. The main advantages of the test are that the patient does not require general anesthesia (is not "asleep" during the test although some sedation may be used) and there are almost never any major side effects. In the past, surgical biopsies were performed more commonly. This type of biopsy requires a laparotomy (an operation in which the surgeon makes an incision through the skin into the wall of the abdomen to examine internal organs). Areas that look or feel abnormal to the surgeon can be sampled by removing a small portion of tissue with a scalpel or through a needle. The surgeon may use a thin needle (as in a fine needle aspiration biopsy). More commonly, surgeons use a wider needle that removes a cylindrical core of tissue (called core needle biopsy). The main disadvantage of this type of biopsy is that the patient must have general anesthesia and remain in the hospital for a period of time to recover. Laparotomy is now rarely recommended. Doctors prefer to use laparoscopy (sometimes called keyhole surgery) as a way of examining and perhaps taking a piece of the pancreas with a biopsy. Patients are usually sedated. Then the surgeon will insert a small telescope-like instrument into the abdominal cavity. This is usually connected to a video monitor. Using this, the surgeon can view the abdomen and see how big the tumor is and whether it has spread. Usually the surgeon will put some gas, usually carbon dioxide, which is quickly absorbed, into the abdomen to make it easier to see everything. Most doctors specializing in treatment of pancreatic cancer try to avoid surgery unless imaging tests indicate a chance that an operation might be able to remove all of the cancer. Even with thorough evaluation by imaging tests and laparoscopy, there are times when the surgeon begins an operation with the intention of completely removing the cancer but, during surgery, finds evidence that it has spread too far beyond the pancreas to be removed completely. In these cases, a sample of the cancer is taken only to confirm the diagnosis, and the rest of the planned operation is stopped. Revised: 03/30/2005 /end quoted text/ > Here is a great link - that will answer most of your questions: > http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas %20resection/whipple%20operation.html which I posted earlier. > Importance of Hospital Volume in the Overall Management of Pancreatic > Cancer. > Annals of Surgery. 228(3):429-438, September 1998. > Sosa, Julie Ann MD *+; Bowman, Helen M. MS ++; Gordon, Toby A. ScD *++; > Bass, Eric B. MD, MPH ; Yeo, Charles J. MD *; Lillemoe, Keith D. MD *; Pitt, > Henry A. MD *; Tielsch, James M. PhD [//]; Cameron, John L. MD That's an old date and the names are supposed to impress us? John, please keep in touch and let us know how it's going. Steph's a doctor and he knows the NHS and he's our expert here. J I answered a question, John answered. I based my answer on facts. Many medical and nursing text books cite relevant journals sometimes with references dating back to 1960's. Some information doesn't change therefore the information is relevant. I would hope the NHS would not offer a patient a treatment it wouldn't pay for, that is why I answered John's question. I wish you well John, being diagnosed with cancer is hard, something that many of us have experienced. I wish you well. I would assume being treated by the NHS they would send you to a center where they perform this surgery therefore can anticipate the best outcome. >> Patients who's cancer is not too advanced do well. the surgeons can >> select [quoted text clipped - 13 lines] > many opinions or travelling if it's adeno type pancreatic cancer. > Unless he expects delays on referral in UK. Hopefully Pat will help you. >polite snip< Actually, this probably is one of those times when the decision making process for the patient is quite different in the UK than that in the US. I was quite thoroughly debriefed after the experience and that has caused me to think long and hard. There were also lots of chances to chat with the surgeons during treatment. They were exceptionally helpful, open and supportive. This operation attracts a lot of attention and controversy. People are interested. I was originally a private patient and intended to remain so, but the logistics and practicalities dictated a transfer to full NHS. In the real world, you just get swept along by the tide of events. Fortunately, that tide was favourable. Perhaps it is more favourable in the UK, than you might expect Since, I have read up on US websites and, not unreasonably in America , the debate is all about the individual surgeon's "score" and the necessity of selecting an expert for the actual operation. Nowadays, you could do that in the UK I suppose, but you would get bogged down in paperwork and unacceptable delays. There is quite a complex series of tests and keyholes leading up to the big day. The question of an individual surgeon's experience is indeed discussed in the UK even with the patient, but under the slightly broader and more realistic euphemism, "centres of excellence." I can't imagine an under experienced surgeon being let loose in a cottage hospital! It is a critical point. It is easy to miss that the operation itself, although long and difficult, does not seem especially dangerous, but the frequent problems, both short and long term, also need extensive and expensive facilities only found in the bigger hospitals - often teaching hospitals. So, choose the biggest hospital? It is not quite so simple. I needed massive and continuous support, not just from a dedicated and fast hi-tech back up, but also, in current British conditions, my wife needed to provide continuous "hands on" nursing both in and out of hospital. The recuperation was long and hard, with pneumonia and blood clots causing emergency readmission. She is not a nurse and was completely exhausted by the time I emerged from real problems at home some six months later. My cherished and unusual lifestyle gave a few problems too as you can imagine: pigs, poultry, cattle and sheep don't feed themselves! Most significantly, she needed to effectively take my place in any decision making process, and to repeatedly explain to me what was going on. You people will know, but I didn't, that long operations can lead to short term memory loss. We didn't know about rigor either. Generally, I was on another planet. Informed consent quickly became a theoretical concept She could not have done it had we gone to London for the treatment. So these decisions are a balance. On a slightly different point, the remark about the operation going ahead even though there may be no certainty that the tumour is malignant is correct. I suspect that the odds of that happening are very low, judging by the reaction of the surgeon, who has very anxious to give me a genuine choice, but was pretty quick to dismiss that as a reason for delay in my case. There is possibly too little emphasis given to the five year survival rate when making these knife edge decisions. So, in the end, it came down to "trust the surgeons." They served me well, treated me with kindness, despatch and dedication. Some of the improvements to the NHS are coming through. Some of the complaints are also well justified, but they are being tackled. It was Norwich. They deserve the praise!  SignatureRegards Pat Gardiner www.go-self-sufficient.com >It was Norwich. They deserve the praise! I have just glanced at your site Pat. Very amusing and interesting. I take my wife to Felixstowe each Friday if she is well. We live in Ipswich. pete SignatureDue to privacy considerations, I will not respond to mail from gmail.com. For more information, please visit www.google-watch.org/gmail.html >>It was Norwich. They deserve the praise! > > I have just glanced at your site Pat. Very amusing and interesting. I > take my wife to Felixstowe each Friday if she is well. We live in > Ipswich. Thank you. I lived in Felixsowe for many years. It has changed a great deal, but it is still nice. SignatureRegards Pat Gardiner www.go-self-sufficient.com > pete > <sorry for the snipping> > The question of an individual surgeon's experience is indeed discussed in > the UK even with the patient, but under the slightly broader and more > realistic euphemism, "centres of excellence." I can't imagine an under > experienced surgeon being let loose in a cottage hospital! Good point ! > [...] > So, in the end, it came down to "trust the surgeons." They served me well, > treated me with kindness, despatch and dedication. > > Some of the improvements to the NHS are coming through. Some of the > complaints are also well justified, but they are being tackled. Thank you sharing your experience, Pat. Very encouraging about the surgeons and the pathology. We had Stan here and was told they could not do surgery because of the location, so at first he was peparing to die. He susequently had a needle biopsy, that must have missed - was told benign. We were elated. Then he decided to go for an ERCP - flew somewhere from US to southern US. They could not get to the tumor that way, so back home he went to recover. Subsequently he went back and had open surgery. They closed him up immediately saying it was adeno and too late. (based on his symptoms when he first posted, I suspected it, and I suspect that his first doctor knew, but he deserved the chance to find out for himself). Unfortunately, he disappeared from newsgroup within a few months. On the other hand, out there somewhere, possibly on the ACOR list, is Don S. I was impressed at how long he had survived, until I learned the he did not have pancreatic cancer, he had B-cell (IIRC) lymphoma of the pancreas, which responds well to chemo. There's no way that I can reply, point by point. If you're in touch (by email) with John, would you please let us know how he's doing? I do hope that he has the same success as you and lots of support during his healing process. We'll be here... J >> <sorry for the snipping> >polite snip< > [quoted text clipped - 3 lines] > he's > doing? He has not been in touch, but I can imagine that all the pressures are on him now. If he does email, I will let you know, of course. > I do hope that he has the same success as you and lots of support during > his > healing process. > We'll be here... > J SignatureRegards Pat Gardiner www.go-self-sufficient.com >On the other hand, out there somewhere, possibly on the ACOR list, is Don S. I >was impressed at how long he had survived, until I learned the he did not have >pancreatic cancer, he had B-cell (IIRC) lymphoma of the pancreas, which responds >well to chemo. Don is still around but not active on any groups or list. He is very ill, he beat the cancer but is dying of a smoking related respiratory disease (COPD, I think). Barbara Hi, this is what my brother, went thru. Two years ago he was a healthy, 45 yo, man with a wife and three children all at home. One day his eyes turned yellow. At first they thought the problem was hepatitis, which must have sent shivers thru work because he was a cook. Then they thought it was gall stones. Then they got it as it was, pancreatic cancer. First he had a minor procedure to replace his bile duct and I think they did a biopsy at that time. They only kept him overnight for that. A week or two later he had the whipple procedure done. They also biopsied his lymph nodes and a lot of them turned up positive (I don't remember how many) but he didn't have another other organ involvement. He was able to enter a study for pancreatic cancer. If he had had too many lymph nodes involved he wouldn't have been able to do that. I don't remember how long he was in the hospital for but it was a lot longer than 14 days. He had trouble getting his stomach to empty into what was left of his intestines and they didn't want him to go home until he could keep food down. The problem did eventually work itself out. Then he started on radiation and chemo. I don't remember how long he did both but it was for months. His operation was early February and I think he finished the chemo in August. He might have finished the radiation earlier than the chemo. The radiation was for five days a week and the chemo varied. He had different chemos, some of it was five days a week, some of it was 24/7, he had to wear a pump around that looked exactly like a fanny pack. He was SICK, SICK, SICK. He barfed constantly and lost a lot of weight. He had to return to work in September because if he didn't he was going to lose his medical benefits. He hadn't used up his sick time because he had worked for years and apparently never called in sick. He did OK for a few months although he did have to take pills to replace enzymes for digestion that the pancreas normally makes and it took 3 flushes to get his poops to go down the toilet and he had trouble with bloating. But he did regain all of his lost weight. I saw him in March and asked him if he would like more chemo. He thought I was kidding, no way did he want more chemo. But I wasn't kidding. I thought he should have more chemo just in case there was more cancer lurking inside of him . Well, there was more cancer lurking inside of him. And it reared it's ugly head in June and he never worked another day in his life. It came back at the exact site as the original cancer and blocked his man made bile duct. It kind of amazes me, the amount of radiation he had to that site and yet it survived. Maybe it didn't survive, maybe whatever it was that caused him to get cancer in the first place struck again. Anyways he had another minor operation to have tubes put in so his bile would drain to a bag on the outside of his body. The doctors never did another thing for him. They said that they couldn't operate because the whipple procedure is such an extensive procedure. He used up his lifetime allotment of radiation with the first tumor and they wouldn't give him any more chemo until his bilirubin came down, which it never did. I'm not blaming the doctors because doctors only, or at least they should only do what the scientists tell them works. But I think scientists have the wrong approach to curing cancer. They try giving this big knock out punch at the beginning and then do nothing. They shouldn't do the big knock out punch at the beginning, which you noticed didn't work anyways, but should give the treatments for a longer time. They should give the cancer an environment in which it cannot survive rather than wait for it to come back. In August his sick time did run out. So then he started collecting food stamps. His wife did not work at all while he was sick. He wanted her home. She said that he wanted her company. I think he needed her to help with the kids, with three their house tends to be a bit of zoo. I don't know when he started barfing again but he was barfing in August when I visited him and he spent the rest of his life barfing. I never knew someone could barf so much. And he started losing weight again. I don't know when he started with the pain meds but he was taking percodan in August. My SIL also developed quite a drug habit with tranquilizers. She went to her doctor, told her what she was dealing with, and he prescribed liberally. So everything is legal. But when they stayed with us at Thanksgiving time, in the morning, before her tranquilizer had kicked in she had the shakes. So I am worried about her. How hard are tranquilizers to get off of? A week after Thanksgiving he had a major bleeding episode in his stomach apparently from a tumor. At the time they said he would not die yet. The next day they then said that he could have died yesterday. It was that bad. That was when they finally told him he was terminal. But he was able to stay home until 12/30/05. The reason he couldn't stay home any longer was because he started hallucinating and was getting too unsteady on his feet. He was also able to get better pain meds in the hospital. He died 1/8/06. A few days before he died he had a conversation with another brother who had died in an accident 25 years ago. I can't help but wonder what that conversation must have been like. Did they pick up from 25 years ago? Did they talk about heaven? Did he tell Dick how his 3 kids had been doing for the past 25 years? It boggles my imagination. Woodpecker Hello woodpecker, I double-checked with a surgeon (as to your question about re-surgery) on sci.med and he replied "> The problem with radical pancreatic resections is that the pancreas is > intimately associated with several vitally important structures. Having > resected it once, the area will now be quite socked in with scar tissue > making the repeat operation quite hazardous and likely impossible. More to > the point, that re-resection won't cure him, nor extend his life in any way. > To re-operate would only put him at risk of death or serious complications > and to no good purpose. I'm sorry." /quote/ > Hi, this is what my brother, went thru. Two years ago he was a healthy, > 45 yo, man with a wife and three children all at home. One day his eyes [quoted text clipped - 6 lines] > biopsied his lymph nodes and a lot of them turned up positive (I don't > remember how many) You posted "several lymph nodes" (a few years back) > but he didn't have another other organ involvement. > He was able to enter a study for pancreatic cancer. If he had had too [quoted text clipped - 7 lines] > tranquilizer had kicked in she had the shakes. So I am worried about > her. How hard are tranquilizers to get off of? She's had a rough time and the loss is so new. She's still got lots of grieving to go through. Lots of people are on tranquilizers. Don't worry about it, unless she's unable to care for the kids or its a driving or work hazard. It's hard being alone, after years of having a partner. It's hard getting accustomed to not having a person beside you for decisions and a warm body to hug and feel the intimacy. It's lonely and it's "alone". If you live nearby and she has no one else, I expect she'll want you around to help with things as you are able? Sometimes silly things (that men usually handle) like climbing a ladder to replace a light bulb, or taking down Christmas decorations, fixing a chair, changing the oil in the car, installing software on the computer, general support while she wades thourgh the months of grieving. If you can't, that's okay as well. Do make sure she's got some support locally for at least a while. There may be a group at the local cancer center/hospital. > A week after Thanksgiving he had a major bleeding episode in > his stomach apparently from a tumor. At the time they said he would not [quoted text clipped - 4 lines] > getting too unsteady on his feet. He was also able to get better pain > meds in the hospital. He died 1/8/06. Thank you for diarying your brother's experience. I'm very sorry for your loss. Sounds similar to my friend's brother, but he died within a year +/- a few months one way or the other. He travelled all over the US, for surgeries and various treatments. As I recall, they also had 3 kids and wife, who followed along. They lived in motels while he was in hospital, while he was getting treatments, 2nd opionions, etc. As best I can recall, he was told inoperable so did not have the Whipple. However, the sister lost track, since they (he and his famly were "on the road" the rest of his life), so he may have - we don't know. > A few days before he died he had a conversation with another > brother who had died in an accident 25 years ago. I can't help but > wonder what that conversation must have been like. Did they pick up > from 25 years ago? Did they talk about heaven? Did he tell Dick how > his 3 kids had been doing for the past 25 years? It boggles my > imagination. They're together now, in a loving and carefree place, forever. I wish you'd stayed with us. We could have been a support system for you and through you, his wife and kids. There's a website owned by a specialist in hospice care. He's blind and had to retire. He wrote a book about what happens when a person is in the final stages of life. If you're ever interested, let us know. We'll point you there. One book is $20. If you want to talk things over, we'll be here. Eventually you might migrate over to alt.support.grief I do hope you'll keep in touch with us, from time to time. Thank you for your post. May you find peace. I'm sure it's hard losing a brother. I know from my friend and thinking what would happen if I lost mine. J Hi J, Thanks. Woodpecker > >On the other hand, out there somewhere, possibly on the ACOR list, is Don S. I > >was impressed at how long he had survived, until I learned the he did not have [quoted text clipped - 4 lines] > ill, he beat the cancer but is dying of a smoking related respiratory > disease (COPD, I think). Probably, but like you, don't know for sure. A friend had lymphoma of the brain and had high dose chemo and stem cell transplant. At last word, there was sstill one tumor, one had almost totally disappeared, another was much smaller; that's not an issue or hasn't been since. She develped a lung condition very similar to cystic fibrosis. (I keep repeating this in case Steph recognizes what it is). Non-smoker. They tried various types of antibiotics, but no luck, She's had numerous hospitalizations. They eventually trained her husband on how to pound her back to bring up the sticky phlegm. And that's how it's been ever since. She's hanging in there. She has a pre-school child they dote on so lots to live for. Thanks for the update on Don, Barbara. Sorry to hear things aren't going well. J > has anybody been through a whiple's procedure for pancreas cancer .. if so > how was it and what it life like afterwards You are jolly lucky to be offered one! I know it does not seem like that at the moment. It is a long arduous operation. Had one just over a year ago. It was tough, partly because my general heath was already poor, but really worth it. A year later, I drove across the US, just to celebrate. I'm not a medical man, but now know that a lot depends on the location. One end and diabetes is the risk, the other, not. I can no longer digest fats, but half a dozen harmless tablets a day soon sorts that out. All other functions entirely normal. Good Luck! If you need any more information email me privately. SignatureRegards PG (male) > > Cheers > > john > "john doughty" <nottsbloke_48@yahoo.co.uk> wrote in message > > has anybody been through a whiple's procedure for pancreas cancer .. if so [quoted text clipped - 8 lines] > > I'm not a medical man, but now know that a lot depends on the location. Hello Pat, I just saw your other post. What do UK surgeons say about keyhole surgery, please? Non-cancer situations such as hysterectomy or gallbladder sure, but I don't trust it for this type of cancer. Thanks J >> "john doughty" <nottsbloke_48@yahoo.co.uk> wrote in message >> > has anybody been through a whiple's procedure for pancreas cancer .. if [quoted text clipped - 21 lines] > Thanks > J Keyhole Whipple's? Daft > "J" <studras@anon.inv> wrote in message > [quoted text clipped - 4 lines] > Keyhole Whipple's? > Daft I meant laproscopic. J >> "J" <studras@anon.inv> wrote in message >> [quoted text clipped - 7 lines] > I meant laproscopic. > J You wouldn't persuade me to go that route. Whipple's is a very demanding operation, but I understand from my surgical oncologists that it requires very good exposure of the tumour and retroperitoneum for two reasons: 1) You need to remove the cancer with good margins 2) If you can't, you need to stop the procedure and back out before you do too much damage. I'm sure it's possible to do radical pancreatectomies via laparoscope, but I haven't seen any data to suggest it's as good or better than laparotomy. My common sense tells me that for the vast majority of Whipple's prospects, it isn't >>> "john doughty" <nottsbloke_48@yahoo.co.uk> wrote in message >>> > has anybody been through a whiple's procedure for pancreas cancer .. [quoted text clipped - 24 lines] > Keyhole Whipple's? > Daft Err, Yes, a bit like the camel through the eye of the needle ;o) Explantion above. SignatureRegards Pat Gardiner www.go-self-sufficient.com > Keyhole Whipple's? > Daft Honestly. I don't know. alex mentioned "non-invasive approach" (in her post) Then she said she posted 2 links but only posted one. The one we both posted mentions laparoscopic but it also says that "We do not offer the laparoscopic Whipple operation for pancreatic adenocarcinoma. " So I don't know what she was talking about... J http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas %20resection/LAP%20PANCREATIC%20SURGERY.html http://www.vioworks.com/clients/sages2003/ Many surgeries once performed by open incision is now done in a non invasive manner including colectomy. The recovery is much simpler but the procedure is more time consuming. > http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/pancreas %20resection/LAP%20PANCREATIC%20SURGERY.html > [quoted text clipped - 3 lines] > invasive manner including colectomy. The recovery is much simpler but the > procedure is more time consuming. Until it's been compared in a randomised trial with standard procedures, it's unknown whether the outcomes or side effects are better, the same or worse >> Keyhole Whipple's? >> Daft [quoted text clipped - 9 lines] > > J I NEVER said laparoscopic I said " the non invasive approach" which is a much smaller incision and use of a laparoscope to assist then a huge incision. The web site says "At USC, Dr P is developing techniques for a laparoscopic Whipple operation. At present this procedure may be offered at USC to selected patients with chronic pancreatitis, cystic tumors and islet cell tumors of the pancreas and patients who have ampullary cancer." Steph may think it is daft, I never suggested it and lap whipples are being examined as an alternative. At one time I heard docs say that lap choles were daft and now they are done routinely. >>> Keyhole Whipple's? >>> Daft [quoted text clipped - 19 lines] > being examined as an alternative. At one time I heard docs say that lap > choles were daft and now they are done routinely. And so for common or garden pancreatic adenocarcinoma it's not being offered. And Whipples is not used for anything other than common or garden pancreatic cancer........... So the entire story is garbage. "alex" <alex@noemail.com> wrote in message > news:08Sdnd9Q9NxLK1DeRVn-oQ@comcast.com... >> [quoted text clipped - 27 lines] > pancreatic cancer........... > So the entire story is garbage. Are you saying that the only way to do a whipple is with the classic wide incision and no other way? With a 14 day recovery? Is that the standard of care in Canada?The popularity of whipples is dying are rarely performed in my area . My only points, go to a facility where they do volume since outcomes are better. The least invasive approach is best. The patients go home with less pain and shorter recovery time. Sorry you don't believe in research, I only pointed out that one MD in a credible medical institution is trying to experiment on a lap whipple. I see new procedures done successfully every day, like lap colectomy. I'm so glad I don't have to be treated by a physician like you. You make the alternative treatments look inviting. <G> . My son is going to England for College Semester, at the first sign of illness, I will have him sent back to the US since, I don't want another child coming home to have surgery the could have been avoided with good basic care. I Alex > "alex" <alex@noemail.com> wrote in message >> news:08Sdnd9Q9NxLK1DeRVn-oQ@comcast.com... [quoted text clipped - 42 lines] > don't want another child coming home to have surgery the could have been > avoided with good basic care. I Alex The worst side effect of treatment is failure to cure a curable cancer. Only a very small percentage of pancreatic cancer patients are suitable for attempted curative surgery, and the majority who do undergo whipples recur and die anyway....... But some are cured, and compromising that chance because of a trendy procedure which may mean less time in hospital but also may mean less chance of cure, is daft. Let your surgeon do the trial and publish the study. Until then it's garbage. He is, as you say, "experimenting" with people's lives. And if you think a colectomy by laparoscope is comparable to a whipple's by laparoscope, I've got some very nice swampland for you in Florida > The worst side effect of treatment is failure to cure a curable cancer. > Only a very small percentage of pancreatic cancer patients are suitable [quoted text clipped - 7 lines] > And if you think a colectomy by laparoscope is comparable to a whipple's > by laparoscope, I've got some very nice swampland for you in Florida The swamp land is for you and that is not " my doctor" but a doctor at an accrediated hospital which the procedure had been presented to the IRB. I have probably spent my time in the OR and caring for surgical patients including many whipple patients performed in the hey day of the surgery. Alex > "alex" <alex@noemail.com> wrote in message > > Are you saying that the only way to do a whipple is with the classic wide [quoted text clipped - 6 lines] > > is trying to experiment on a lap whipple. I see new procedures done > > successfully every day, like lap colectomy. http://www.annalsofsurgery.com/pt/ http://tinyurl.com/9vcbc Therapeutic Laparoscopy of the Pancreas. Annals of Surgery. 236(2):149-158, August 2002. Park, Adrian E. MD, FRCCS, FACS *; Heniford, B. Todd MD, FACS + Abstract: Objective: To communicate results of laparoscopic treatment of pancreatic pseudocyst (PP) and resection of benign lesions of the pancreas. Perioperative data, surgical outcomes, techniques and insights from 54 cases are presented. Conclusions: In the authors' experience, minimally invasive treatment of PP produces good results and avoids difficulties linked with percutaneous drainage or endoscopic internal procedures. However, combining upper endoscopy with intragastric laparoscopic surgery offers advantages of both. LDP compares well to open procedures and often allows preservation of the spleen > The worst side effect of treatment is failure to cure a curable cancer. > Only a very small percentage of pancreatic cancer patients are suitable for [quoted text clipped - 7 lines] > And if you think a colectomy by laparoscope is comparable to a whipple's by > laparoscope, I've got some very nice swampland for you in Florida http://www.bioscience.org/1998/v3/e/iannitti/3.htm 3.3. Laparoscopic resection Laparoscopic approaches to various surgical procedures such as cholecystectomy and hernia repair are commonplace. As experience with laparoscopic surgery has grown, attempts at various abdominal procedures have been carried out. Laparoscopic resection for pancreatic tumors is a developing field (29-31). Gagner and Pomp reported the first successful pancreaticoduodenectomy in 1994 (32). The procedure can be performed completely laparoscopically or by hand-assisted via a Pneumo-Sleeve (Pilling-Weck, North Carolina) device in which a small incision is made so that a hand can be inserted within the abdomen and pneumoperitoneum is maintained. Hand-assisted resections are technically significantly easier and faster to perform. Additionally, an incision needs to be made for eventual specimen removal. Certainly adequacy of resection, tumor spillage, and morbidity are significant concerns in laparoscopic pancreaticoduodenectomy. However, further experience with this approach is needed before meaningful conclusions can be made. Nonetheless, laparoscopic pancreatic resections are technically demanding and should only be performed by surgeons with extensive experience in laparoscopic procedures and open pancreatic resections, in very carefully selected patients. 3.4. Laparoscopic palliation The overall resectability rate of pancreatic cancer remains low at approximately 15%. Therefore, the majority of therapy carried out for patients with pancreatic cancer remains to be palliation of complication. Three main complications include biliary obstruction, duodenal obstruction, and pain. These complications can be treated by radiographic, endoscopic, open surgical, and laparoscopic surgical approaches (33). http://www.pancan.org/Patient/Related/documents/talamonti_000.pdf PanCAN Interview 2221 Rosecrans Ave, Suite 131 El Segundo, CA 90245 Phone: (877) 272-6226 Fax: (310) 725-0029 www.pancan.org Dr. Mark Talamonti April 2004 PanCANs Medical Advisory Council (MAC) PanCAN is creating a new Medical Advisory Council (MAC) to assist with medical and clinical aspects of our mission and programs. It is with great pleasure that we welcome Dr. Mark Talamonti, a surgical oncologist at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University, as the Chairman of the PanCAN Medical Advisory Council. Q: How did you become interested in caring specifically for people with pancreatic cancer? A: My interest in caring for people with pancreatic cancer began to evolve during my fellowship at the MD Anderson Cancer Center. It became clear to me that pancreatic cancer poses a significant medical challenge. The patients needs are great and the impact that a physician can make in their care is so profound that it is something I ultimately found personally interesting, challenging, and meaningful. Q: Can you share about your familys personal experience with pancreatic cancer? A: In December of 2002 my father was diagnosed with pancreatic cancer. He died suddenly five days after the diagnosis, probably from a pulmonary embolism. What was most humbling about this experience was that despite my obvious professional and academic interest in pancreatic cancer, I was not able to recognize the disease in my own father until it was already well advanced. I saw in my father the same courage in the face of this diagnosis that I have seen in so many of my own patients. Any caring person and certainly any aware physician cannot help but be moved by these patients. Q: Is there research being done on the topic of laparoscopic Whipple procedures? If so, what is the progress of that procedure? A: Diagnostic and potentially therapeutic laparoscopic procedures are being increasingly done for patients with pancreatic cancer. Currently, the major role of laparoscopy for patients with pancreatic cancer is to serve as a diagnostic aid in determining the presence or absence of occult metastatic disease. In addition, laparoscopic resection of small, cystic tumors in the body and tail of the pancreas has been proven to be effective, safe and beneficial to the patient. Laparoscopic Whipple procedures have been reported and are still being attempted. Whether the short-term benefits of laparoscopic Whipple procedures are real, and whether there is any prolonged benefit remains to be determined. Certainly, I would caution that laparoscopic procedures for benign disease might not have the same relevancy as laparoscopic procedures for malignant disease. One of the great controversies will be in trying to apply laparoscopic pancreatic resections for patients with known pancreatic carcinomas. Any compromise in the oncologic soundness of the operation would negate any potential benefit from a minimally invasive approach. /quoted text/ J The great thing about living in a great city like Boston, you get to see therapies way ahead of the curve. I see treatments that are ground breaking and cutting edge. I know from personal experience with my dad's cancer treatment, husband's and my own cancer treatment we were both given options years before "it became the standard of care". You could not find these options on the internet since they where too new to be published. Patients are not informed of these treatments unless you find these doctors. > The great thing about living in a great city like Boston, you get to see > therapies way ahead of the curve. I see treatments that are ground [quoted text clipped - 4 lines] > published. Patients are not informed of these treatments unless you find > these doctors. A new thing becomes an appropriate "standard of care" when some enthusiast or other tests it appropriately in the setting of a clinical trial, and it is proven safe and effective. The reason high dose chemotherapy and bone marrow transplant became a "standard of care" in the US for high-risk breast cancer was because nobody bothered to do the trials. As a result many people were damaged, and much money wasted. Eventually the trials were done, and the "standard of care" was shown up for the disaster that it was. I've been listening to oncologists from "great cities like Boston" telling the world that cancer was on the verge of being eradicated by chemotherapy for 25 years......... Real progress is hard, grinding, frustrating work, not prima donnas dancing around trying to make headlines and careers by seeing how big a cancer can be extracted from how small a hole. Or at least most of the cancer. > Keyhole Whipple's? > Daft Surg Endosc. 2004 Apr;18(4):717-8. Epub 2004 Feb 2. Related Articles, Links Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Ammori BJ. Department of Surgery, Hepatopancreatobiliary and Laparoscopic Unit, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, England, United Kingdom. Bammori@aol.com BACKGROUND: By and large, the limited world experience with laparoscopic pancreaticoduodenectomy (PD) has been unfavorable, but the laparoscopic hand-assisted approach to PD has recently shown promising results. We report the first successful UK experience with laparoscopic hand-assisted PD (LHAPD). METHODS: A 62-year-old man who presented with painless obstructive jaundice was found at endoscopy, to have an ampullary tumor. Preoperative biopsy specimens confirmed the diagnosis of an adenocarcinoma, and CT showed no evidence of either vascular involvement or metastatic disease. A staging laparoscopy showed no intraabdominal metastases, and an LHAPD was performed using a Gelport. RESULTS: The intraoperative course was uneventful. Two units of blood were transfused intraoperatively, but no postoperative blood transfusion was required. The operative time was 11 h (plus a 30-min break). The patient's postoperative recovery was uneventful except for superficial pressure sores over the buttocks and elbows. The patient resumed oral fluid and dietary intake on the 1st and 3rd postoperative days, respectively, and was discharged from hospital on the 9th postoperative day. Histology demonstrated an ampullary adenocarcinoma with clear resection margins and involvement of two of the 13 lymph nodes examined. At 2-month follow-up, the patient remains well and is receiving adjuvant chemotherapy. CONCLUSIONS: LHAPD achieves good oncological clearance and can be performed safely in selected patients. The early promising results with this approach will undoubtedly encourage wider adoption of this procedure and are likely to widen the selection criteria. Hand-assisted laparoscopic pylorus-preserving pancreaticoduodenectomy for pancreas head disease. Kimura Y, Hirata K, Mukaiya M, Mizuguchi T, Koito K, Katsuramaki T. First Department of Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. kimuray@sapmed.ac.jp Laparoscopic procedures for pancreatic surgery have been significantly improved recently; however, the number of successful laparoscopic or laparoscopy-assisted pancreaticoduodenectomies (PDs) has been limited. The limitations could be attributed to the complexity of the reconstruction procedures under laparoscopic observations and the high incidence of critical morbidity with PDs. To overcome the shortcomings, we developed the first hand-assisted laparoscopic pylorus-preserving PD and, in this report, present the case of a patient with a low-grade malignant tumor on the pancreas head. > > Keyhole Whipple's? > > Daft [quoted text clipped - 12 lines] > present the case of a patient with a low-grade malignant tumor on the > pancreas head. shrug J >> > Keyhole Whipple's? >> > Daft [quoted text clipped - 18 lines] > shrug > J Another "low grade" tumour. >> "john doughty" <nottsbloke_48@yahoo.co.uk> wrote in message >> > has anybody been through a whiple's procedure for pancreas cancer .. if [quoted text clipped - 21 lines] > Thanks > J I'll explain as best I can. Do remember that I have no knowledge of medicine beyond that of a regular consumer. Every decade for the last five, I have had a major operation, with both private and NHS treatment, so I can make comparisons from a consumer's view without any bias between private and public care It looked like a classic gallbladder problem, but a tumour was quickly spotted, by scan, in the head of the pancreas. I was admitted for further tests, basically to see if a Whipple was likely to be possible. As I had a pre-existing heart condition and some other possibly precancerous conditions, that seems sensible. The ECGs and X-rays etc were frequent all the way through. The keyhole surgery was mainly to check the liver. The initial news was bad: a probable spread. But then lab analysis showed the tumours were benign. When the news came through, a very delighted surgery team virtually bounced around the ward. I was amazed at the number of nursing staff that asked my permission to be present at the operation. Rather than frightening me, that was a massive morale boost. I felt well cared for by an interested team. The operation went ahead. Things went well, really well. All the new connections held. We later learned that the surgeon decided to take some lymph nodes out -11. 10 were OK, one was not, so that was a good decision too. I was sent home after a couple of weeks, rip-roaring and ready to go. Within no time, I was walking 4 miles, but then lethargy and fevers set in; a blood clot and pneumonia forced a readmission. That's what I meant when I said Mr Doughty was "jolly lucky", the NHS go to a lot of trouble to make sure they are not wasting resources to distress "lost causes", the fact that he was offered one is automatic good news. SignatureRegards Pat Gardiner www.go-self-sufficient.com > has anybody been through a whiple's procedure for pancreas cancer .. if so > how was it and what it life like afterwards Now that the serious discussion is over, am I the only one who pictured an old guy squeezing toilet paper? (For you eastpondians, <http://en.wikipedia.org/wiki/Mr._Whipple>.) SignatureIf John McCain gets the 2008 Republican Presidential nomination, my vote for President will be a write-in for Jiang Zemin. >> has anybody been through a whiple's procedure for pancreas cancer .. >> if so how was it and what it life like afterwards > > Now that the serious discussion is over, am I the only one who > pictured an old guy squeezing toilet paper? Actually, I thought nuns wore them. Fig > >> has anybody been through a whiple's procedure for pancreas cancer .. > >> if so how was it and what it life like afterwards [quoted text clipped - 3 lines] > > > Actually, I thought nuns wore them. Humour is in the eye of the beholder and it sure wouldn't be humourous to read these if: I'd been told there's nothing more to be done; if I'd just been diagnosed with pancreatic cancer; if I'd just been told that my brother's pancreatic cancer had returned Please remember your audience. J Hi John The whipple procedure is a complex operation and it is best to have the operation performed by a surgeon that does a lot of them. A high percentage of Whipple procedures "fail", meaning the doctors pronounces the patient inoperable after seeing the full extent of the cancer. Experienced surgeons generally have a much higher success rate. I would suggest that you go to www.acor.org and follow the procedures to subscribe to the pancreatic cancer list. Then just send an e-mail to the list with all your questions and you will be able to get the names and contact info for the best facilities and surgeons. It is an active group and even if it seems quiet at the time you join, after you ask you will get plenty of responses. There are many post-Whipple patients on the list and you can get lots of tips for post-Whipple care. Barbara |
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