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Less Invasive Approaches for Pancreatic Cancer Surgery

The Whipple procedure is the major operation most commonly used to remove pancreatic tumors. Washington University hepatobiliary-pancreatic and gastrointestinal (HPB-GI) surgeons at Barnes-Jewish Hospital have worked for two decades to make the surgery safer. Now they are reducing the impact of the surgery through the use of minimally invasive techniques, thereby improving quality of life for patients.

The five-year survival rate for pancreas cancer is only 8 percent, but the Whipple   offers the only chance for cure when pancreas cancer is located in the head of the organ. It also has had a high mortality rate (20 percent two decades ago), but surgeons at Barnes-Jewish Hospital and other high-volume centers have worked to make it safer; it is now 1 to 2 percent here.

Major pancreas and cancer operations are the last frontier in minimally invasive surgery. Last year, Washington University HPB-GI surgeon Chet Hammill, MD, MCR, began performing minimally invasive (MI) robotic distal pancreatectomy to remove cancer from the tail of the pancreas. Surgeon Dominic Sanford, MD, has followed the with the MI Whipple. Both operations reduce hospital length of stay and typically result in a quicker recovery.

Sanford joined the faculty in August 2018 after completing a hepatobiliary, pancreatic, and liver transplant fellowship at Washington University followed by a minimally invasive pancreas surgery fellowship at Mayo Clinic in Florida under the direction of Horacio Asbun, MD, who first performed the MI Whipple in 1999. At Mayo, Sanford worked under Asbun’s supervision numerous times after having performed the open operation about 70 times as a Washington University surgery resident and HPB fellow.

“The most feared complication is leakage when we connect the pancreas to the intestine,” says Sanford. “Doing this over and over again with one of the ‘fathers’ of this operation was huge.”

Sanford eventually plans to use robotic surgery to sew the pancreas to the intestine, which will make teaching the MI Whipple procedure to residents and fellows easier. Over time, this will expand the number of surgeons who can perform the operation safely.