Harvard Health Letter

The Whipple procedure

Better outcomes for pancreatic cancer surgery.

Pancreatic cancer has been in the public eye lately because it has afflicted several prominent people, including Supreme Court Justice Ruth Bader Ginsburg, Apple CEO Steve Jobs, actor Patrick Swayze, and Randy Pausch, a computer science professor at Carnegie Mellon University whose inspirational last lecture became a YouTube sensation and, as a book, a national best seller.

It's odd that the disease would strike so many famous people at about the same time, because pancreatic cancer is fairly uncommon. Nearly 38,000 Americans were diagnosed with the disease in 2008, a fraction of the 215,000 who will be diagnosed with lung cancer. The media attention isn't hard to fathom, though. It's morbid interest: no other common cancer has such a poor prognosis. Only about 5% of those diagnosed with pancreatic cancer are alive five years later, in contrast to about 66% of colon cancer patients and 90% of female breast cancer patients. For a variety of reasons — screening, earlier diagnosis, better treatment — cancer isn't the proverbial death sentence it once was. For many, it is a survivable (if harrowing) condition that can be lived with for many years in relative good health. Pancreatic cancer stands out as a throwback.

But one bright spot in pancreatic cancer treatment is improved results for the Whipple procedure, the operation most often used to treat the disease. In the 1970s, over 15% of the patients who had the procedure died during the operation or shortly afterward. Improvements in surgical technique, anesthesia, and postoperative care have driven that rate into the low single digits at some hospitals, and the five-year survival rate after the operation may be as high as 20%. Studies have consistently shown that results are better at hospitals where many Whipples are done, and the operation is held up as an example of why steering patients to high-volume centers for complex surgeries and treatments might be one way to improve the quality of health care and treatment outcomes.

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