audib
Regular
Joined: 29 Jun 2007
Posts: 17
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 Posted: Sat Jun 30, 2007 3:40 pm Post subject: Prognosis after whipple procedure |
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I apologize if this subject has been discussed before-I have been reading on this forum and did not see it discussed too much so I am asking this question.
My father in law was just diagnosed with stage 2 pancreatic cancer and just was in the hospital for a shunt due to jaundice. He also had a laproscopy and they felt he was suitable for surgery. The surgeon that he wants will be away for a few weeks so the surgery is scheduled for 7/19/07. They tell him he can wait, but my husband and I are concerned that waiting the 3 weeks may not be the right thing. There is another surgeon who can operate about 9 days sooner. Should we have the surgery moved up or waiting the 9 days really wont matter that much? It seems to be causing changes in his body almost daily so my inclination is to move it up but my father in law only wants this one particular surgeon who has a good reputation with the Whipple. One of his physicians told my husband that sometimes this procedure is done as corrective and sometimes it is just palliative and in my father in laws case, he felt it was pallliative. So, do you put someone through this 8 hour surgery with complications and a long recovery time? I know it is someone's life and possibly his only chance, but I read that the mortality rate is high even after the Whipple-is this fair to do to the patient and their family if there is only a few more months of extended life? We are very confused and most likely will do the surgery and wait until the 19th but was just wondering if anyone has an opinion about doing this procedure at all or moving it up. Thanks for any advice you could offer and I wish the best to all those who are suffering from this disease. |
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freeio
Senior User
Joined: 20 Dec 2004
Posts: 116
Location: Guntersville, Alabama
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| Posted: Sat Jun 30, 2007 4:26 pm Post subject: Post-Whipple reality |
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Let me give you a brief statement of my background before directly answering your question. My Whipple procedure was on October 21, 2004, after my initial diagnosis with what they thought was stage I pancreatic adenocarcinoma. I have passed two and a half years since then, and while I am now in stage IV, I am still alive. Pancreatic cancer is almost always a death sentence, and the primary question is how long the patient has to live, and what are the circumstances of that remaining life. My life is testimony to the fact that some of us last quite a while before the cancer gets us, and so the Whipple procedure may be a reasonable thing to do.
The delay itself would not necessarily worry me. The difference of nine days is not material. The question with the Whipple procedure is how experienced the surgeon is - i.e. how often does she/he do this most complicated surgery? In my case, my surgeon was Dr. Selwyn Vickers, who had performed about 40 of them per year for the last several years before mine. The one thing you do not want is someone who is not seriously experienced, as the surgery is so massive and invasive that it does not take much of a wrong step to kill the patient all by itself. Go with the doctor with experience.
As to the question of life after the surgery, I will say that it is, for me, much better than it was before the surgery. The shunt / stent is a necessary but insufficient method for opening up the bile duct. It helps get the pressure off, and to get the biliruben level down in preparation for surgery, but it is just not enough to do the job by itself. If there is going to be a six month prognosis at all, the surgery is probably necessary. It took about two months to get over mine enough to be allowed to proceed with radiation treatments, and by day fourteen after the surgery the positive change was dramatic.
Now there are no guarantees whatsoever in all of this. I had a friend who had the same surgery with the same team six months after mine, and she never made it out of the hospital. Seven weeks later she was gone. I was hospitalized in the same ward at the time, and it was devestating to everyone to see this.
In short, I cannot make decisions for you. The question of whether a Whipple procedure is ever curative is not one I can answer. Pancreatic cancer is so very pernicious that I have seen nearly no one ever make it to the five year point. Nevertheless, in my case it was a necessary step for me to live this long, regardless of what may happen tomorrow. What are a few more months of life worth? Mine have been priceless.
You might want to look over my pancreatic cancer blog which is listed below. You will see tat I have had a real roller-coaster ride.
Best Regards,
Marty
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whipple procedure, Oct. 21, 2004
28 days of radiation
56 days of Chemo using Xeloda
diagnosed as progressive recurrent pancreatic adenocarcinoma (Stage IV) Jun. 20, 2006
was treated with gemcitabine, oxaliplatin, and tarceva, which all failed.
Cancer blog: http://diehlmartin.com/cancer.html |
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audib
Regular
Joined: 29 Jun 2007
Posts: 17
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| Posted: Sat Jun 30, 2007 6:19 pm Post subject: prognosis after whipple |
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| Thanks for your quick and heartfelt reply. My father in law is very confident in his surgeon. Dr Joe Levi of University of Miami Jackson Memorial Hospital supposedly does close to 80-90 Whipples/year. Someone who is at Sloan Kettering told us to go with him although the other surgeon who is available is also good and trained at Sloan Kettering. It is just that in the 2 weeks since he has been diagnosed I have seen him deteriorate-the jaundice, discomfort, weakness etc. seems to have increased so dramatically that I didn't want to wait if we can have the surgery done sooner. My father in law truly believes he will have this surgery and recover and live on another 15-20 years because his own mother lived to be 100. In the 35 years I have known him, he has never been in the hospital or been treated for anything serious. I don't think he understands the realism of this disease and while my husband does, he doesn't want to accept it and chooses to believe like his dad. I have researched the Whipple and understand it to be a very extreme surgery and didn't know if it was worth going through but I am sure it is if it extends ones life some. thans |
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