Whipple surgery for 81 year-old mom

I should also add that, post-treatment, my digestion has not been effected.

I was not able to have the surgery because of METS to the Liver. I am 66 but I have heard that it is difficult to recover from. Nano Knife might be an option if it has not spread. Google it. Dr Donoway is the expert in that procedure. He is out of Florida.

Hello @alisonsullivan203 and welcome to Mayo Connect. I see that several Connect members have already responded to your post.

Before making a decision on any major surgery, it is always wise to seek a second opinion. Here is a link to an article from Mayo Clinic's cancer blog, about tips for obtaining a second opinion, https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/tips-for-seeking-a-second-opinion/

Is your mom being seen at a Pancreatic Center of Excellence? If not, getting a second opinion from one of these organizations would be a good choice. Mayo Clinic is a Pancreatic Center of Excellence. They have three locations. If you are interested in a second opinion from a Mayo physician, here is a link with information on how to obtain an appointment, http://mayocl.in/1mtmR63. If an appointment at Mayo is not possible, here is a website (from the National Pancreas Foundation) where you can find other Pancreatic Centers of Excellence, https://pancreasfoundation.org/patient-resources/npf-centers-of-excellence/
Would you and your mom be open to getting a second opinion prior to surgery? The more information you have prior to surgery, will help you make the best decision.

How is your mom feeling?

@alisonsullivan203 : A few thoughts to consider --

Is your 81-year old mother in pretty good overall condition, other than the new pancreatic cancer?

Does she have a good support system of people to help her recover for about 8 weeks after the surgery?

Can you get her to a high-volume pancreatic center of excellence for the surgery?

If those answers are yes, Whipple doesn't sound like a bad option to me. It can be done laparoscopically or open. My surgeon preferred the open option to minimize time under anesthesia and get the best visibility of what he was doing. I experienced a good bit of fatigue and digestive "upset" for about 6 weeks after surgery, until I healed some and got a good handle on the enzyme requirements and eliminated foods that were never gonna work for me. (Bye-bye BBQ ribs. 🙁 )

The chemo and radiation treatments are open to discussion. Some surgeons will insist on chemo before surgery. Some may insist or recommend it after surgery, regardless. And if they don't get complete R0 (clean) resection), she'll get prescribed chemo and/or radiation after the surgery anyway, when it's much harder to tolerate.

My intuition (based only on my own experience, with zero medical training) is to take out the cancer you know is there first with a method (surgery) that is known to be curative, rather than pre-treat with chemo in the hope/assumption it "might" kill cancer (microscopic spread) that "might" be somewhere else.

There's a lot more to consider than I can type here today, but in terms of chemo, the two primary standards of care are Folfirinox ("F") and Gem/Abrax ("GA"). Docs generally give "F" to younger patients, and "GA" to the elderly, based on tolerance. "F" is generally considered superior, so if docs only wanted to give her GA, it might not be that effective anyway.

@markymarkfl covers the territory very well. He is an amazing resource for us. But, most importantly, where is your mother at—what’s she thinking, how’s she feeling, what does she want? What is she up for? The bottom line with PC is that 1) it is different for every individual and 2) there are no guarantees. I wish you and your mother all the best.

Since she is staged 2a, perhaps it has spread only to a lymph node?
Where is the tumor located? The term whipple is used broadly but in fact, if the tumor is in the tail or the body, she may be eligible for pancreadectomy and not a “re-plumb” of her digestive tract.
This does not eliminate the need for a further systemic treatment, since it only takes a few cells to get loose and hide for awhile before they debut in the liver or lung. So you do have things to consider. Get 2nd and 3rd opinions for sure!

Hello @alisonsullivan203,

You mentioned that your mom would be seeing a surgeon early this week. After her appointment, would you post an update at your convenience?

All of this information, advice, and insights are incredibly helpful. Thank you all so much. We met with the surgeon yesterday and he is recommending 4 months of chemo prior to surgery to both address the margins (her tumor is getting close to some major vessels) and kill off any cancer cells floating around in her body. She’s still hopeful, but without knowing how she’ll react to the chemo - especially at first when they’re guessing how much and the frequency - she’s overwhelmed by a desire to “just be normal again.” For now, the Whipple is still on the table and as long as the chemo does its job, looking like that it will be her decision to opt for the open surgery.

It sounds like there is a game plan which is a great start. Do you know what chemo is being suggested? The "just be normal again" is a tough one. The mental and emotional side effects are sometimes worse than the physical side effects of chemo and surgery. What can she do today to help her feel more normal? What does she enjoy that is simple? Reading? Sitting with friends and family? Watching a movie? For me, keeping my mind occupied and staying busy kept my mind from going to places that weren't helpful. I believe keeping a positive attitude positively helps the body.