Pancreatoduodenectomy for pancreatic head carcinoma with or without pylorus preservation

Background/Aims: With the concept of less invasive surgery, PpPD (pylorus-p reserving pancreato-duodenectomy) has taken the place of conventional Whipp le pancreatoduodenectomy (Whipple) as a standard operation for pancreatic h ead carcinoma. The aim of this paper is to compare early and late postopera tive results of PpPD and Whipple for pancreatic head carcinoma. Methodology: Postoperative clinical follow-up data and outcome of 50 Japane se patients with pancreatic head carcinoma who underwent pancreatoduodenect omy with or without pylorus preservation were reviewed to scrutinize the de merits and merits of the pylorus preservation. Results: Preoperative and postoperative serum chemistry was not different b etween the two groups. Mean operation time of the Whipple group was 517 min utes, which was significantly shorter than 624 minutes of the PpPD group (P = 0.0006). Cumulative stage was not different between the two groups. Cumu lative curability of the PpPD group was superior to the Whipple group; of t he 27 patients with Whipple, A in 4, B in 5 and C in 18, while of the 23 pa tients with PpPD, A in 12, B in 2 and C in 9 (P = 0.0182). Gastric tube was removed on POD 6.0 in the Whipple group, while on POD 39 in the PpPD group (P < 0.0001). Oral intake was started on POD 14.0 in the Whipple group, wh ile on POD 28.3 in the PpPD group (P = 0.0018). Discharge was on POD 57.8 i n the Whipple group, while POD 86.9 in the PpPD group (P = 0.0023). At the time of discharge and postoperative 6, 12, and 18 months, body weight loss from the preoperative level was 1 kg smaller in the PpPD group than in the Whipple group. 1-year and 3-year survival rates of the Whipple group was 53 .8% and 15.8%, while 62.8% and 19.6% of the PpPD group, showing no signific ant difference. Conclusions: These data show that delayed gastric emptying is evident in th e PpPD group, resulting in longer hospital stay, while long-term body weigh t loss is smaller in this group. The clinical outcome is similar between th e two groups. PpPD can be accepted as a standard operation for pancreatic h ead carcinoma.