title: Results of a pylorus-preserving pancreatoduodenectomy for pancreatic cancer: a comparison with results of the Whipple procedure.
abstract: OBJECTIVE
  A pylorous-preserving pancreatoduodenectomy (PPPD) was performed in patients with an invasive ductal adenocarcinoma of the pancreatic head, but with no direct invasion to the duodenal bulb or pyloric ring and no perigastric lymph node metastasis. This study compares the results achieved by the Whipple procedure in patients with invasive ductal adenocarcinoma of the pancreatic head.
  
  
  METHODS
  Over the past 14 years, we have treated 109 patients with an invasive ductal adenocarcinoma of the head of the pancreas, this number excluding low-grade malignancies such as intraductal papillary mucinous carcinoma or cystadenocarcinoma. The postoperative survival rate, level of postoperative social activity and changes in body weight were studied in 48 resected patients and compared with the results of those who underwent the Whipple procedure.
  
  
  RESULTS
  In the resected patients, the 3-year survival rate was 20.8%, and the 5-year survival rate was 16.7%. All patients who underwent the bypass operation, however, had a survival rate of less than 2 years, hence the prognosis for resected patients was better (p < 0.01). Among the resected patients, the postoperative survival rate was better in those who underwent a curative resection than in those who underwent a non-curative resection (p < 0.01). No difference was observed in the postoperative survival rate of PPPD vs Whipple procedure patients. The level of postoperative resumption of social activity and changes in body weight were significantly better after the PPPD than after the Whipple operation.
  
  
  CONCLUSIONS
  For patients with cancer of the pancreatic head, but with no direct invasion of the duodenal bulb or pyloric ring and no perigastric lymph node metastasis, a PPPD proved more effective than the Whipple operation. Further, as the prognosis was also better after curative resection, an extended lymphadenectomy in conjunction with the PPPD was also considered necessary to ensure a cancer-free state following resection.
authors.affiliation: First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Takada
authors.forename: H
authors.initials: H
authors.lastname: Yasuda
authors.forename: H
authors.initials: H
authors.lastname: Amano
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: H
authors.initials: H
authors.lastname: Ando
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011708:Pylorus / Q000502:physiology*; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome