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Whipple’s Procedure (also known as pancreaticoduodenectomy) is a major surgical operation most commonly performed to treat cancers located in the head of the pancreas, but also used for other periampullary or duodenal pathologies.

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Clinical considerations

Indications

https://teachmesurgery.com/hpb/pancreas/pancreatic-cancer/

Malignant	Benign
Pancreatic head adenocarcinoma (most common)	Chronic pancreatitis (in selected cases)
Ampullary carcinoma	Pancreatic cystic neoplasms
Distal cholangiocarcinoma	Neuroendocrine tumors
Duodenal carcinoma
Metastatic lesions to pancreas (rare)

Preoperative Evaluation

CT scan (pancreas protocol): evaluate resectability (vascular involvement, metastasis)
MRI/MRCP or EUS: better ductal anatomy, small lesion detection
CA 19-9: tumor marker (baseline)
Staging laparoscopy: in high-risk or borderline resectable cases

Contraindications

Distant metastases (liver, peritoneum)
Unresectable vascular invasion (e.g., SMA encasement >180°)
Poor functional status or severe comorbidities

Procedure

The classic Whipple includes resection of: