ON ONCOLOGIC HAZARDS OF PYLORUS-PRESERVIN G PANCREATICODUODENECTOMY IN DUCTAL CARCINOMA

Between 1986 and 1993 fifty-two patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy, 34 in a standard Whipple technique (Whipple), 18 since 1990 preserving the pylorus (PP PD). Operating time was significantly longer for Whipple compared to P PPD (5.5 +/- 1.4 vs. 3.8 +/- 1.0; p < 0.01). Postoperative morbidity ( 32 vs. 56%) resulted to 50% after PPPD of early postoperative delayed gastric emptying. Hospital mortality was 6% vs. none, respectively. Hi stopathologic workup of 28 node positive Whipple specimens revealed no de involvement in only 11% along the stomach (1) or the pyloric region (2), but in these cases tumors had obviously close relation to the ga stric outlet as the reason to chose Whipple. Actuarial survival was ve ry similar in both groups, being 41 vs. 53% at one year, 13 vs. 18% at two years, and only 3.3% at five years for the whole cohort. In concl usion distal gastric resection in Whipple's procedure in ductal carcin oma is oncologically not effective. There is no hazard for survival re lating to the preservation of the pylorus. Therefore PPPD as the techn ically less expensive and for nutritional status more benificial opera tion should be the procedure of choice also for this type of tumor.