title: Pylorus-preserving total pancreatectomy. Early and late results.
abstract: OBJECTIVE
  Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse.
  
  
  METHODS
  A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99.
  
  
  RESULTS
  11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5-66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus.
  
  
  CONCLUSIONS
  Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: K
authors.initials: K
authors.lastname: Z'graggen
authors.forename: C E
authors.initials: CE
authors.lastname: Vagianos
authors.forename: C A
authors.initials: CA
authors.lastname: Redaelli
authors.forename: F
authors.initials: F
authors.lastname: Holzinger
authors.forename: C
authors.initials: C
authors.lastname: Sadowski
authors.forename: C
authors.initials: C
authors.lastname: Kulli
authors.forename: H
authors.initials: H
authors.lastname: Zimmermann
authors.forename: H U
authors.initials: HU
authors.lastname: Baer
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D001835:Body Weight; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome