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Surgical resection of lesions of the head of the pancreas

Howard A Reber, MD
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD


Pancreaticoduodenectomy is a complex, high-risk surgical procedure. The lowest operative mortality rates and best long-term cancer outcomes have been demonstrated at high-volume centers [1,2]. In experienced hands, the median operative time for the Whipple procedure is 5.5 hours, with a median blood loss of 350 mL and mortality of less than 4 percent [3].

Resection of the head of the pancreas is indicated primarily for neoplasms, and necessitates concomitant duodenal resection. Pancreaticoduodenectomy may also be needed to manage pancreatic or duodenal trauma, and chronic pancreatitis.

The perioperative management and general techniques for resection of the head of the pancreas are reviewed here. An overview of the surgical management of cancers involving the exocrine pancreas is presented in detail elsewhere. (See "Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis".)


The most common indication for resection of the head of the pancreas is the presence of a malignant or premalignant neoplasm of the pancreas or one of the other periampullary structures (bile duct, ampulla, or duodenum) [4-6]. Certain types of neoplasms may be amenable to local excision (enucleation), and some benign conditions may also require pancreatic head resection.

Pancreatic adenocarcinoma (see "Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis")

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Literature review current through: Nov 2017. | This topic last updated: Oct 09, 2017.
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