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This text discusses Whipple's procedure, also known as pancreaticoduodenectomy, and its therapeutic strategies, including chemotherapy with gemcitabine administered at 1000 mg/m² weekly. It highlights the role of percutaneous biliary drainage in managing obstructive jaundice, particularly when endoscopic options fail. The document provides insights into the prognosis post-surgery, noting that median survival for patients ranges from 4 to 6 months, with specifics on long-term survival and complications. Essential for understanding these complex interventions.
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Whipple’s procedure • a.k.a. Pancreaticoduodenectomy
Chemotherapy • Deoxycytidine analogue gemcitabine • 1000 mg/m2 weekly for 7 weeks followed by 1 week rest, then weekly for 3 weeks every 4 weeks thereafter
Percutaneous Biliary Drainage • Percutaneous transhepaticbiliary drainage is used preoperatively to decompress the biliary tree and prevent complications aggravated by bile spillage. • Drainage of the biliary tree by the introduction of a catheter through the liver and into the biliary tree under radiologic guidance. Also called percutaneoustranshepaticcholangiodrainage.
Indication for PTBD • To relieve obstructive jaundice when the endoscopic retrograde approach has failed or is not indicated
September 2, 2011 St. Luke’s Medical Center Percutaneous Biliary Drainage
Dilated common bile duct Needle
Guide wire Cut off area
Catheter Gallbladder
Prognosis • Median survival time for all patients is 4-6 months. • Patients who survive for 5 years after successful surgery may still die of recurrent disease years after the 5-year survival point. • The occasional patient with metastatic disease or locally advanced disease who survives beyond 2-3 years die of complications
