Evolution of the Whipple procedure at the Massachusetts General Hospital

Carlos Fernández-Del Castillo, Vicente Morales-Oyarvide, Deborah McGrath, Jennifer A. Wargo, Cristina R. Ferrone, Sarah P. Thayer, Keith D. Lillemoe, Andrew L. Warshaw

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). Methods: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. Results: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). Conclusion: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.

Original languageEnglish (US)
Pages (from-to)S56-S63
JournalSurgery (United States)
Volume152
Issue number3 SUPPL.
DOIs
StatePublished - Sep 1 2012

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General Hospitals
Pancreaticoduodenectomy
Reoperation
Pancreatic Fistula
Perioperative Care
Hospital Records
Gastric Emptying
Pylorus
Names
Medical Records
Cause of Death
Shock
Length of Stay
Sepsis
Adenocarcinoma
Observation
Demography
Databases
Hemorrhage
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Fernández-Del Castillo, C., Morales-Oyarvide, V., McGrath, D., Wargo, J. A., Ferrone, C. R., Thayer, S. P., ... Warshaw, A. L. (2012). Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery (United States), 152(3 SUPPL.), S56-S63. https://doi.org/10.1016/j.surg.2012.05.022

Evolution of the Whipple procedure at the Massachusetts General Hospital. / Fernández-Del Castillo, Carlos; Morales-Oyarvide, Vicente; McGrath, Deborah; Wargo, Jennifer A.; Ferrone, Cristina R.; Thayer, Sarah P.; Lillemoe, Keith D.; Warshaw, Andrew L.

In: Surgery (United States), Vol. 152, No. 3 SUPPL., 01.09.2012, p. S56-S63.

Research output: Contribution to journalArticle

Fernández-Del Castillo, C, Morales-Oyarvide, V, McGrath, D, Wargo, JA, Ferrone, CR, Thayer, SP, Lillemoe, KD & Warshaw, AL 2012, 'Evolution of the Whipple procedure at the Massachusetts General Hospital', Surgery (United States), vol. 152, no. 3 SUPPL., pp. S56-S63. https://doi.org/10.1016/j.surg.2012.05.022
Fernández-Del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP et al. Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery (United States). 2012 Sep 1;152(3 SUPPL.):S56-S63. https://doi.org/10.1016/j.surg.2012.05.022
Fernández-Del Castillo, Carlos ; Morales-Oyarvide, Vicente ; McGrath, Deborah ; Wargo, Jennifer A. ; Ferrone, Cristina R. ; Thayer, Sarah P. ; Lillemoe, Keith D. ; Warshaw, Andrew L. / Evolution of the Whipple procedure at the Massachusetts General Hospital. In: Surgery (United States). 2012 ; Vol. 152, No. 3 SUPPL. pp. S56-S63.
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abstract = "Background: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). Methods: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. Results: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36{\%}). Pylorus preservation has been the most important variation in technique, accounting for 45{\%} of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13{\%}). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45{\%} to 0.8{\%}, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19{\%}). Conclusion: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving.",
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