Treatment For Pancreatic Cancer is best done in Tertiary Referral Centre

Since I left for private practice in 2004,I actively avoid doing Whipples Operation for Periampullary Cancers.

Periampullary Cancers are a collection of cancers within a narrow area of anatomy in the second part of the Duodenum called The Ampulla of Vater.
They are made of;
1.Cancer of the Head of Pancreas
2.Cancer of the Ampulla of Vater
3.Cancer of the Lower Bile Duct(Cholangiocarcinoma)
4.Cancer of the Duodenum

The final exact diagnosis of the Periampullary Cancer is very often made after the Radical Surgery is performed.

Whipple Operation is considered Radical because of 2 reasons:
1.the removal of adjacent lymph nodes
2.the removal of many adjacent organs which may alter the body's physiological function at a later date

Despite my avoidance of Whipples operation over the last 11 years, I still ended up doing two cases who had been rejected by a few tertiary referral centres that I referred to on the grounds of;

1.patients were too old(both in their later 60s and early 70s)
2.high surgical risk

After obtaining a high risk informed consent from patients and family members, and passed by the preoperative Anaesthetic assessment, I performed the Whipples operations.

One patient had no complication after surgery.The other patient developed Pancreatic Fistula postoperatively but recovered after medical treatment.

I strongly believe Whipples operations and other pancreatic operations are best done in Tertiary Referral Centres which are usually high volume centres for a few reasons;

1.doing many operations will sustain the surgical skills of the surgical team and hence,
2.the risk of major complications will be minimised
3.the database can be maintained and be a source of audit and research

http://www.cancernetwork.com/pancreatic-cancer/treatment-high-volume-center-improved-pancreatic-cancer-survival