Which is a less invasive pancreatic head resection: PD, PPPD, or DPPHR?

Less invasive pancreatic head resection, such as pylorus preserving pancrea toduodenectomy (PPPD) and duodenum preserving pancreatic head resection (DP PHR) has been introduced for the treatment of pancreatoduodenal lesions, es pecially for benign conditions, in consideration of postoperative quality o f life. Surgical stress and exocrine and endocrine function of the residual pancreas were examined in 44 patients with PPPD, 10 with conventional panc reatoduodenectomy (PD) and six with DPPHR. Clinical findings including seru m levels of C reactive protein (CRP), fasting blood sugar, a 120-min value of the 75-g oral glucose tolerance test (OGTT), N-benzol-L-tyrosyl-p-aminob enzoic acid (BT-PABA) excretion value (a pancreatic exocrine-function test) ; and volume of postoperative pancreatic juice drainage were compared among the three different variants of pancreatectomy. Operation time and operati ve blood loss in PD:were largest of the three, followed by PPPD and DPPHR. Postoperative elevation of serum CRP ion postoperative day (POD) 2 or 3 was similar among the three different types of operation. Fasting blood sugar concentrations were not different among the three groups at short- and long -term after the operation, while the 120-min value of the GTT showed a mark ed elevation at long-term only after PPPD. The volume of pancreatic juice d rainage increased up to POD 4 and became constant thereafter. The total amo unt of pancreatic juice drainage from POD 4 to 13 was smallest in PD (637 m i) followed by PPPD (1255 mi) and DPPHR (1431 mi). The BT-PABA value declin ed after PD (-20.3%, P = 0.0437) and PPPD (-20.2%, P = 0.0239) at short ter m, but not after DPPHR (8.2%). These findings suggest that the early impair ment of the pancreatic exocrine function after PD and PPPD but not after DP PHR may indicate that the invasiveness of pancreatic head resection to the pancreatic functions is greater in PD and PPPD than in DPPHR.