Comparision between a Pylorus-Preserving and a Whipple Pancreaticoduodenectomy

ABSTRACT

The aim of this study was to establish whether the pylorus-preserving pancreatico-duodenectomy (PPPD) is a safe, but radical, procedure in the treatment of malignant periampullary lesions, without increased morbidity and mortality rates, compared with the standard Whipple's procedure (PD). From 1993 to 1996, a PD (N = 25) or a PPPD(N = 15) was performed on 40 patients. Postoperative mortality rates were 2% after the PD and 0% after the PPPD. The mean operation time and blood loss in the PPPD group were 465 minutes and 840ml, respectively, and in the PD group were 444 minutes and 1080ml, respectively, both statistically insignificant. During follow-up, no differences were found in the postoperative complications, the recurrence of disease, and survival rates according to operation type, lymph node metastasis, or pancreas invasion. No differences were found the numbers of days of gastric drainage, liquid diet, and regular diet, but a delayed gastric emptying time was found in the PPPD group(40% of the patients after PPPD vs 12% after PD). Tumor-containing duodenal or gastric resection margins were not found in either group of patients. The hospital stay was the same for both groups (38 days after PPPD, 37 days after PD). The mean duration of follow-up was 23 months. Weight gain fter operation during follow-up was relatively more favorable after a PPPD. In conclusion, a PPPD is a safe, but radical, procedure and can be an alternative choice, without compromising curability. to a PD in the treatment periampullary cancer. No difference in either the morbidity or the mortality rates existed between the two procedures. Further investigation will be needed to understand the delayed gastric emptying time in the PPPD group, but during 3 months, of follow-up weight gain was better in the PPPD group.