PpPD and PD for Advanced Carcinoma of the Head of the Pancreas

Shin Takahashi, Kouichi Aiura, Junichi Saitou, Sigeo Hayatsu, Soujun Hoshimoto, Keiichi Suzuki, Masaki Kitajima and Yosirou Ogata

Dopartment of Surgery, Keio University School of Medicine
^*Department of Surgery, Tochigi Cancer Center

In recent years pylorus-preserving pancreatoduodenectomy (PpPD) has come to be widely used in Japan to treat cancer in the pancreatic head region, but the indications for advanced cancer of the pancreatic head remain a matter of controversy. In this study we conducted a comparative assessment of the results of treating advanced pancreatic head cancer (stage III, IVa, and IVb) by PpPD and by pancreatoduodenectomy (PD). The subjects of this study were 76 patients with stage III, IVa, or IVb advanced pancreatic head cancer resected between September 1983 and December 1997. PpPD was performed in 22 of the patients (PpPD group), and PD was performed in the other 54 patients (PD group). Postoperative complications, pathohistological findings, postoperative QOL, mode of recurrence, and survival time were compared in the two groups. No significant differences were observed in the incidence of postoperative complications, especially the incidence of delayed gastric emptying. There were no differences between the groups in lymph node metastasis status, plx-positive rate, or mode of recurrence. PS was well maintained in both groups, and the rate of postoperative recovery of body weight was more favorable in the PpPD group until 1.5 years postoperatively. There were no significant differences in the survival rates, but the results from 2 years onward were more favorable in the PpPD group. If the indications are present, PpPD can be performed without reducing curability even in advanced pancreatic head cancer, and because of the excellent gastrointestinal absorptive function in the early postoperative period, it is a surgical procedure that will replace PD.

Key words
advanced carcinoma of the head of the pancreas, pylorus-preserving pancreatoduodenectomy, pancreatoduodenectomy

Reprint requests
Shin Takahashi Department of Surgery, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 JAPAN

Accepted
July 28, 1999

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