Whipple Surgery

I would greatly appreciate responses from those people who have had a similar experience to mine and could give me some guidance.  I went to Mayo Clinic in Rochester, Minnesota during July.  While I was there, I had a CAT SCAN related to the prostate.  The specialist found nothing abnormal concerning that physical area.  However, the radiologist discovered a 3 cm cyst in my pancreas.  After conducting an endoscopic ultrasound down my throat, a physician determined the cyst was benign.  Nonetheless, the gastroenterologists advised me to have the growth surgically removed to eliminate the possibility it could become malignant.  The doctors regard a 3 cm cyst in the pancreas to be too large to merely observe.   As I understand the condition, that size has a greater tendency than a smaller one to become cancerous.

I would have to experience a whipple procedure that even the Mayo doctors consider a very serious and extensive surgery with potential undesired side effects/health consequences.  The literature quoted a 40% “morbidity” rate (i.e., unexpected surgical development).  I was told that my chances of the cyst becoming cancerous over the next five years is somewhere around 10-15%.  I am tempted to have a follow up “imagery” done in January (6 months after the first images) through an MRI and/or CAT Scan to determine if the cyst is growing or not and might have been from my wishful perspective “dormant” for years. 

 I really do not know how to proceed in this situation. It seems somewhat like a “catch 22” circumstance (i.e., Both choices might be “wrong.”).  I would be grateful to receive responses from other people who have experienced a similar situation if not identical and worked his/her way through it hopefully without harm.  Your guidance would be sincerely appreciated during a troubling period of my life.

 I am in the same condition with a slightly larger cyst (3.8 cm), discovered as a result of another potential medical concern which turned out to be minor. I am surprised that anyone assigned you a risk factor, since my reading of the literature thus far suggests that there is not a procedure to determine how and when a mucinous cyst can become malignant. Or exactly how the transformation occurs. Did you see Dr. Todd Baron at Rochester who I have heard/read is developing some new techniques with what is called a scope within a scope or duo endoscopic? From what I read I am not clear whether this would help to determine the degree of risk if you decide to just monitor the cyst. 

I agree with you that this is a tough  decision and I have talked to several non -Mayo doctors familiar with the Whipple, including a surgeon who did some of these procedures some years back, and generally they suggest going the monitoring route and opting for the procedure only if the cyst increases in size and/or another standard symptom shows up. I also have read a number of studies which appear to indicate that many cysts are shown to be completely benign after removal. Were they caught early and would have changed over time? It is not stated. Also, some may have  been there a long time, since some evidence suggests these cysts can develop over a 10 to 15 year period?

At my age (76) I wonder if the the procedure is worth it in terms of post-procedure quality of life as I have no symptoms and am very active. My approach right now is to monitor the cyst every 3 months by CAT scan and blood tests. The two surgeons I met with wanted to go to surgery immediately but I did not hear  a completely rational explanation of why except that there might be some cells in the cyst that could be or could become malignant. Yet, Cancer of the pancreas is swift and survival is a low percentage.

Let me know how they determined that your risk is 10-15% over the next 5 years. Having studied probability theory I wonder how they came up with that figure and what would be the probability  of dying in some kind of accident or from some other non-related medical condition in the next 5 years at our ages..

Best of luck with whatever decision you make or have made.

On 8/28/2008 al-teacher wrote:

I would greatly appreciate responses from those people who have had a similar experience to mine and could give me some guidance.  I went to Mayo Clinic in Rochester, Minnesota during July.  While I was there, I had a CAT SCAN related to the prostate.  The specialist found nothing abnormal concerning that physical area.  However, the radiologist discovered a 3 cm cyst in my pancreas.  After conducting an endoscopic ultrasound down my throat, a physician determined the cyst was benign.  Nonetheless, the gastroenterologists advised me to have the growth surgically removed to eliminate the possibility it could become malignant.  The doctors regard a 3 cm cyst in the pancreas to be too large to merely observe.   As I understand the condition, that size has a greater tendency than a smaller one to become cancerous.

 

I would have to experience a whipple procedure that even the Mayo doctors consider a very serious and extensive surgery with potential undesired side effects/health consequences.  The literature quoted a 40% “morbidity” rate (i.e., unexpected surgical development).  I was told that my chances of the cyst becoming cancerous over the next five years is somewhere around 10-15%.  I am tempted to have a follow up “imagery” done in January (6 months after the first images) through an MRI and/or CAT Scan to determine if the cyst is growing or not and might have been from my wishful perspective “dormant” for years. 

 

 I really do not know how to proceed in this situation. It seems somewhat like a “catch 22” circumstance (i.e., Both choices might be “wrong.”).  I would be grateful to receive responses from other people who have experienced a similar situation if not identical and worked his/her way through it hopefully without harm.  Your guidance would be sincerely appreciated during a troubling period of my life.

Hi, I've just come across your message so not sure if you are still monitoring this but just in case you are:

I can't comment on your specific situation as mine was slightly different.  I was given a 90% chance last year that a cist in my pancreas was cancer but thankfully in the end it turned out to be Chronic Pancreatis.  I had my Whipple last August and am now pretty much back to normal.  The operation wasn't pleasant and I was in hospital for 10 days but once home I started on the road to recovery.  Don't expect things to get back to normal quickly - It was 2/3 months before I started feeling like myself again.  I was advised that the recovery period was about a year and to be honest that's pretty accurate.  The hardest thing was regaining my energy levels. The only long term problem I have now is not being able to digest my food - so I have to take tablets with everything I eat, but that's nothing compared to what could have happened if the original diagnoses was correct.  All the best and keep positive.     

I had my whipple done in 2001. My situation was a little different. I had Chronic pancreatis and was so sick I spent more time in the hospital than at home. I did a lot of research and found Dr. Avram Cooperman in New York. He is world renouned for doing the whipple surgery. The man is very very good! One of his patients now is actor Patrick Swayze.

When no one else would touch me because I was so young, he listened to me, reviewed ALL of my records from over the years, gave me a complete physical and did a great job with the surgery. It was very painful and I had a lot of different complications but over the years I have regained my life and a good share of my health. If you want more information from me just reply to this and I will tell you all I can.

Good luck

Mari

On 8/28/2008 al-teacher wrote:

I would greatly appreciate responses from those people who have had a similar experience to mine and could give me some guidance.  I went to Mayo Clinic in Rochester, Minnesota during July.  While I was there, I had a CAT SCAN related to the prostate.  The specialist found nothing abnormal concerning that physical area.  However, the radiologist discovered a 3 cm cyst in my pancreas.  After conducting an endoscopic ultrasound down my throat, a physician determined the cyst was benign.  Nonetheless, the gastroenterologists advised me to have the growth surgically removed to eliminate the possibility it could become malignant.  The doctors regard a 3 cm cyst in the pancreas to be too large to merely observe.   As I understand the condition, that size has a greater tendency than a smaller one to become cancerous.

 

I would have to experience a whipple procedure that even the Mayo doctors consider a very serious and extensive surgery with potential undesired side effects/health consequences.  The literature quoted a 40% “morbidity” rate (i.e., unexpected surgical development).  I was told that my chances of the cyst becoming cancerous over the next five years is somewhere around 10-15%.  I am tempted to have a follow up “imagery” done in January (6 months after the first images) through an MRI and/or CAT Scan to determine if the cyst is growing or not and might have been from my wishful perspective “dormant” for years. 

 

 I really do not know how to proceed in this situation. It seems somewhat like a “catch 22” circumstance (i.e., Both choices might be “wrong.”).  I would be grateful to receive responses from other people who have experienced a similar situation if not identical and worked his/her way through it hopefully without harm.  Your guidance would be sincerely appreciated during a troubling period of my life.