Prospective nonrandomized comparison between pylorus-preserving and subtotal stomach-preserving pancreaticoduodenectomy from the perspectives of DGE occurrence and postoperative digestive functions.
BACKGROUND
To determine the influence of pylorus preservation after pancreaticoduodenectomy, we compared the postoperative course of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD).


METHODS
A prospective, nonrandomized comparison of 77 consecutive patients undergoing PPPD (n = 37) or SSPPD (n = 40) between January 2003 and March 2007 was planned. The early postoperative course, dietary intake, and the incidence of delayed gastric emptying (DGE) were evaluated.


RESULTS
SSPPD included significantly more cases of regional lymph node dissection (D2, PPPD 53% vs. SSPPD 80%) and portal vein resection. The median duration of surgery (457 vs. 520 min) was significantly shorter, and blood loss (619 vs. 1,235 ml) was significantly less in PPPD. Regarding postoperative clinical factors, the duration of nasogastric tube intubation (1 vs.1 day), days until solid diet (7 vs. 7 days), and the incidence of DGE (9% vs.10%) were similar in PPPD and SSPPD. However, the postoperative/preoperative body weight ratio (95% vs. 93%) was significantly higher, and the postoperative hospital stay (31 vs. 38 days) was significantly shorter in PPPD (p < 0.05).


CONCLUSIONS
Despite the bias of the operative factors, the incidence of DGE and postoperative dietary intake after SSPPD was comparable with PPPD, and therefore, pylorus preservation seemed to have no impact on postoperative dietary intake or DGE.
Akizuki
Emi
E
Department of Surgical Oncology and Gastroenterological Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8543, Japan. akizuki@sapmed.ac.jp
Kimura
Yasutoshi
Y
Nobuoka
Takayuki
T
Imamura
Masafumi
M
Nishidate
Toshihiko
T
Mizuguchi
Toru
T
Furuhata
Tomohisa
T
Hirata
Koichi
K
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D011708:Pylorus / Q000503:physiopathology / Q000601:surgery*; D013272:Stomach Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D016896:Treatment Outcome