PYLORUS-PRESERVING PANCREATICODUODENECTOMY FOR CARCINOMA OF THE PANCREAS

Patients with carcinoma of the pancreas continue to be associated with a poor outcome, with surgical resection representing the only possibi lity of cure. The classic operation described by Whipple in 1935 has u ndergone many modifications with Traverso and Long-mire reintroducing preservation of the pylorus in an attempt to decrease the sequelae fro m the gastrectomy and improve nutritional outcome. Since 1979, the Lah ey Clinic has performed pylorus-preserving pancreatoduodenectomy for t he management of pancreatic and periampullary tumors as long as the du odenal margin is free of tumor and the antropyloric area appears viabl e. This article reviews the pattern of pancreatic tumor spread and the margins frequently involved with tumor. The management of distal bili ary obstruction, our technique of pylorus-preserving pancreatoduodenec tomy and our results of 106 pylorus-preserving pancreatoduodenectomies for pancreatic and periampullary carcinoma are discussed. We feel tha t pylorus-preserving pancreatoduodenectomy can achieve results as a ca ncer operation similar to the standard Whipple operation while elimina ting the side effects related to gastric resection and improve the nut ritional status of the patient. (C) 1995 Wiley-Liss, Inc.