PYLORUS-PRESERVING WHIPPLE RESECTION FOR PANCREATIC-CANCER - IS IT ANY BETTER

Objective: To compare the short- and long-term morbidity and mortality rates of the standard Whipple pancreatoduodenectomy (SW) and its pylo rus-preserving modification (PPW) in patients with malignant periampul lary disease. Design: Retrospective medical record review and quality of Life assessment by telephone interview. Setting: University medical center. Study Participants: Sixty-seven patients who underwent pancre atoduodenectomy (52 SW and 15 PPW) from June 1988 to January 1994. Int ervention: The SW and PPW. Main Outcome Measures: Operative features a nd short- and long-term complications were analyzed with respect to th e type and stage of cancer and the kind of pancreatic resection. Mean follow-up was 32 months (range, 1 to 5 years). Results: The operative mortality rate for all patients who had a pancreatic resection was 1.5 %. The diagnoses in the PPW vs SW groups were pancreatic cancer (four vs 27 patients), ampullary cancer (six vs seven patients), duodenal ca ncer (zero vs six patients), and bile duct cancer (five vs one patient ). Operative mortality rates (0%, vs 1.55%) and operative times (2 min utes longer for SW) were similar. Delayed gastric emptying (61% vs 41% ) was more common in the PPW group, resulting in a longer hospitalizat ion (24 vs 18 days) and a greater cost in the PPW group (P=.04). In th e PPW group, a mean of five lymph nodes was removed compared with 10 i n the SW group (P=.04). Conclusions: The data provided no evidence of any advantage for the PPW in patients with malignant periampullary tum ors. We continue to advocate the SW for pancreatic cancer.