Pylorus-Preserving Pancreatoduodenectomy for Invasive Ductal Adenocarcinoma of the Pancreas: Comparison to the Conventional Pancreatoduodenectomy

Ryo Hosotani, Ryuichiro Doi and Masayuki Imamura

Department of Surgery and Surgical Basic Science, Kyoto University

During the past seventeen years, 84 patients underwent standard Whipple procedures and 16 patients received a pylorus-preserving procedure for invasive adenocarcinoma of the head of the pancreas. A retrospective review of the clinical records was carried out, and the short-and long-term surgical outcomes were compared between the two patient groups. Successful surgery with no pathological residual tumor was obtained in 75.0% of the patients who underwent the pylorus-preserving procedure and 70.2% of those who underwent the standard Whipple procedure. Pathology revealed lymph node metastasis of the infra-pyloric node in eight patients who were operated on with the standard Whipple procedure but none occurred in patients who underwent the pylorus-preserving procedure. Operative morbidity and mortality were not significantly different between the two groups. Multivariate and univariate analyses for the two procedures showed no differences on the survival of the patients. However, the pylorus-preserving procedure patients showed better postoperative nutritional necovery; the increase of body weight and nutritional parameters, such as total cholesterol levels, hemoglobin levels and albumin levels in the pylorus-preserving procedure patients were significantly greater than the standard procedure patients. The results indicate that the pylorus-preserving Whipple procedure is performed without losing operative curability and is in favor of the patients' quality of life, therefore, it might be a procedure of choice for invasive adenocarcinoma of the pancreas.

Key words
pancreatoduodenectomy, quality of life, treatment outcome

Reprint requests
Ryo Hosotani Department of Surgery and Surgical Basic Science, Kyoto University 54 Shogoin-kawaracho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
July 28, 1999

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