During a pancreaticoduodenectomy (Whipple procedure), which structures are typically removed?

• A. Pancreatic head and tail
• B. Duodenum and jejunum
• C. Pancreatic head, duodenum, gallbladder, and proximal small intestine
• D. Pancreatic head, duodenum, gallbladder, distal stomach, and common bile duct

Answer: (D)

In a pancreaticoduodenectomy, the goal is to achieve oncologic clearance for disease in the pancreatic head by removing the structures most commonly involved in that region. This typically means taking out the pancreatic head together with the duodenum, the gallbladder, the distal portion of the stomach near the pylorus, and the common bile duct. These tissues are closely linked anatomically and share lymphatic drainage, so removing them in one specimen helps ensure complete tumor removal and clear margins. After resection, the digestive and biliary pathways are rebuilt: the stomach remnant is connected to the jejunum (gastrojejunostomy), the hepatic duct is connected to the jejunum (hepaticojejunostomy), and the pancreatic remnant is connected to the jejunum (pancreaticojejunostomy). This reconstruction restores continuity of the GI tract and bile and pancreatic juices. The other options would miss one or more of these essential components or imply a different approach (such as preserving portions that are typically removed in the standard Whipple).