Master of the Whipple Gave Hope, Extended Lives

Cheryl Alkon
Published: Sunday, Aug 19, 2018
John L. Cameron, MD
John L. Cameron, MD
In his exemplary practice of medicine, John L. Cameron, MD, lives by a few guiding principles.

“I have a few statements I’m fond of, and the first is, ‘If you pick a profession you love, you never have to work a day in your life,’” he says. “Taking care of patients, helping them, performing surgeries, and dealing with their families—it’s the best job there is.”

His next favorite, he adds, addresses the ongoing learning process inherent in medicine. “‘Good judgment comes from experience, and experience comes from bad judgment.’ Even though you make mistakes, you learn from them and get a little smarter.”

These are fitting phrases for Cameron, the Alfred Blalock Distinguished Service Professor in the Department of Surgery at The Johns Hopkins University School of Medicine and the world’s foremost expert in the Whipple procedure, a surgery that treats the highly fatal disease known as pancreatic cancer. He has completed more than 2000 Whipple operations, or pancreaticoduodenectomies, more than anyone else in the world.

Named for Allen Oldfather Whipple, MD, who wrote about it in 1935, the procedure treats pancreatic cancer by removing the head of the pancreas, a good part of the duodenum, some of the bile duct, the gallbladder, and nearby lymph nodes. Sometimes the whole pancreas, duodenum, and part of the stomach are taken out. It is a complicated process, taking up to 6 hours or longer, that requires long periods of recuperation in the hospital. According to a journal article on the subject, the Whipple is considered “one of the most challenging surgical procedures, which requires the highest level of surgical expertise.”1

Although the Whipple is a difficult operation, it gives some patients with pancreatic cancer hope when little else avails. Cameron’s work performing the Whipple and teaching others to do it well have helped extend the lives of many patients with pancreatic cancer. Today, the 5-year survival rate for patients who have had the operation is about 25%; for those who are treated before the cancer has spread to the lymph nodes, 5-year survival rates are closer to 40%. In the 1980s, when Cameron began performing the operation, about 25% of those who had a Whipple died. Now, at Hopkins the rate is 2% or below. Without the Whipple, pancreatic cancer would claim far more victims.

A colleague quoted in a 2012 Baltimore Sun story about Cameron’s 2000th procedure noted how deeply Cameron has influenced others. “A lot of surgeons do the operation well because [Cameron] trained them,” according to Julie A. Freischlag, MD, who succeeded Cameron as chair of Hopkins’ Department of Surgery and currently serves as chief executive officer of Wake Forest Baptist Medical Center and dean of the Wake Forest School of Medicine in Winston-Salem, North Carolina.

A Hopkins' Legacy

Cameron decided to specialize in performing the Whipple when, in 1984, he became chairman of the Department of Surgery and director of the Section of Surgical Sciences at Hopkins, where he had worked since attending the Johns Hopkins School of Medicine. He earned his medical degree in 1962, served his surgical residency from 1962 to 1970, and served as a clinical and research fellow for the next year. He also spent 2 years, from 1963 to 1965, as a research surgeon for the US Army at the Walter Reed Army Institute of Research.

Cameron became chairman of Hopkins’ surgical department following a meteoric rise from assistant to associate to full professor in just 7 years. “It was, at that time, a record,” Cameron says. He recruited colleagues to join him at the surgical department. That was in the mid-1980s. “I had to promise them they could do all the surgery in their fields that they wanted,” he says.

That left him to focus on pancreatic cancer, which at the time had very little to offer patients in terms of treatment or long-term survival. “Nobody wanted to operate on the pancreas, because if you did a Whipple, which was recommended for only 25% of all patients with pancreatic cancer, everyone died,” he recalls. “When I became chair, I picked pancreatic cancer to focus on because there were virtually no 5-year survivors.”

Once Cameron began doing Whipples, the success rate began to improve. Better technique, improved selection of candidates for surgery, superior anesthesia and postoperative care, and repetition have all contributed to reduced mortality for those undergoing the procedure.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Medical Crossfire®: Navigating Treatment Decisions in Pancreatic Cancer: Key QuestionsJun 29, 20191.5
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