A 70-year-old man presents with painless progressive jaundice, pale stools, and dark urine. CT shows a 2.8 cm hypodense mass in the head of the pancreas with bile duct and pancreatic duct dilatation ('double duct sign'). CA 19-9 is markedly elevated. There is no vascular involvement and no distant metastases. What is the standard surgical procedure?
- A Whipple's pancreaticoduodenectomy (classic or pylorus-preserving) ✓
- B Distal pancreatectomy with splenectomy
- C Total pancreatectomy
- D Biliary bypass (choledochojejunostomy) as primary treatment
Correct answer: A. Whipple's pancreaticoduodenectomy (classic or pylorus-preserving)
Explanation
Resectable cancer of the head of the pancreas is treated by pancreaticoduodenectomy (Whipple's procedure or its pylorus-preserving variant). The operation removes the pancreatic head, duodenum, distal common bile duct, gallbladder, and the proximal jejunum, with reconstruction by pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy. Distal pancreatectomy is for body/tail lesions. Total pancreatectomy is rarely required. Biliary bypass is palliative for unresectable disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.