Whipple is a one time procedure. The organs resected do not regenerate so it is impossible to do the procedure as the GI tract has already been resected and reconfigured. Metastatic disease has to be addressed either by more adjuvant chemotherapy and or other methods such as various types of radiation, Histotripsy or ablative technique. The choice depends on location of metastatic disease.

Next Generation Sequencing (NGS) can be done on a surgical tissue specimen and those are always archived for decades by pathology departments. If a fresh core needle biopsy is obtainable, it might show mutations that have occurred after chemo was done that conferred resistance leading to metastatic disease. NGS testing is done at specialized sequencing laboratories. Those labs are limited as are the very expensive instrumentation to perform this time-consuming process. The backlog and time in transit until receipt of specimens takes 3-4 weeks. It makes sense to wait for results as standard of care only gets standard results and survival statistics make it evident that targeted therapies, immunotherapies and clinical trials offer potential for a better outcome.

After I had genetic testing done, it identified a mutation that was targetable. It also told the oncologist the most appropriate chemo regimen to use and what category of clinical trials to search for. As a result, I have surpassed 12.5 years survival of metastatic pancreatic cancer and considered by leading pancreatic cancer oncologists as cured.