Clinicopathological Outcome of Patients Undergoing Whipple’s Operation- A Retrospective Study over a Decade in a Tertiary Care Centre

Abstract

Introduction: The surgical procedure pancreaticoduodenectomy is popularly known as Whipple’s operation. Whipple procedure is one of the major surgeries performed in tertiary care centres. Aim: The present research was undertaken to study indications of Whipple’s operation and also to evaluate pathological findings of periampullary tumours with biochemical investigations. Materials and Methods: This retrospective study was conducted in total 155 patients who had undergone Whipple’s operation over a period of ten years from January 2009 to December 2019 at a tertiary care hospital in a central India. The hematoxylin and Eosin (H&E) stained slides were reviewed and various parameters were studied like presence or absence of the tumour, site of origin of tumour (ampulla/ head of pancreas/distal common bile duct/ duodenum), histological type (adenocarcinoma/neuroendocrine/ lymphoma), differentiation (well/moderate/poor), depth of invasion, Lymphovascular Invasion (LVI), perineural infiltration, lymph node status (metastasis), resection margin status (involved/not involved) and {Tumour (T), Nodes (N), Metastasis (M)} staging. Perioperative complications and postoperative follow-up of minimum 30 days for all patients were studied. Results: The most common indication for Whipple’s operation was periampullary carcinoma irrespective of its site of origin and was most commonly seen in males in age group of 51-60 years. Out of total 155 cases, four cases were excluded as no tumours were found in those cases. Tumours from ampulla were most common (101) followed by those from Common Bile Duct (CBD) (22) and pancreas (22) and duodenum (6). The median size of the tumour in Whipple's specimen was 1.44 cm2. Most frequent histological type was adenocarcinoma (145, 96.02%). Moderate differentiation was most commonly observed histological grade in periampullary carcinomas 116 (76.8%). Perineural and lymphovascular infiltration was seen more commonly in pancreatic cancers 90.9% (20/22). Lymph node metastasis was significantly high in pancreatic cancers. Perioperative complications were seen in 32 patients with common complications were biliary leak. The perioperative mortality was 7.9%. Distal cholangiocarcinoma was found to be more aggressive followed by pancreatic and ampullary cancers. Conclusion: Whipple procedure is associated with a unique set of common complications and continues to be associated with considerable morbidity. With careful patient selection, Whipple procedure can be performed safely.