Pylorus-preserving total pancreatectomy - Early and late results

Background/Aims: Preservation of the pylorus is an accepted alternative pro cedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse. Methods:A p rospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99. Results: 11 pa tients underwent total pancreatectomy with preservation of the pylorus. His topathological examination revealed pancreatic adenocarcinoma in 16 cases a nd duodenal adenocarcinoma in 1 patient, 5 patients had other types of panc reatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidi ty was 59% and reoperations were performed in 9.1% of cases (n = 2). Median followup was 37 months (range 5-66). 62% of patients (n = 13) developed tu mor recurrence and 13 patients died during the follow-up period with 10 dea ths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-pre serving total pancreatectomy or pancreatectomy with gastrectomy. However, p ostoperative body weight was increased 3, 6, 9 and 12 months following pres ervation of the pylorus. Conclusion: Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term surviva l but improved nutritional recovery compared with standard total pancreatec tomy. Copyright (C) 2001 S. Karger AG, Basel.