title: Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures.
abstract: BACKGROUND
  Pylorus-preserving pancreatoduodenectomy (PPPD) has replaced conventional pancreatoduodenectomy with a distal gastrectomy (cPD) as the most commonly performed procedure. However, there has been no evidence from prospective studies to indicate the overwhelming superiority of PPPD over cPD. A recent report revealed that resection of the pyloric ring reduced the incidence of delayed gastric emptying (DGE) in a randomized controlled trial.
  
  
  METHODS
  In 158 patients with pancreatic head cancer, the perioperative outcomes and long-term nutritional consequences were retrospectively compared among three types of pancreatoduodenectomy: cPD; PPPD; and subtotal stomach-preserving pancreatoduodenectomy (SSPPD), in which the pyloric ring and duodenum were removed and more than 90% of the stomach was preserved.
  
  
  RESULTS
  The incidence of DGE was significantly higher in the PPPD group than in the cPD and SSPPD groups (27.3 vs. 5.8 and 5.4%, respectively; P = 0.0012). The serum albumin concentration and total lymphocyte count at 1 year postoperatively were significantly higher in the SSPPD group than in the PPPD group (P = 0.0303 and P = 0.0203, respectively). The patients in the SSPPD group showed longer survival times than the patients in the cPD and PPPD groups (median survival times, 21.3, 17.1, and 17.7 months, respectively), although the differences did not reach statistical significance.
  
  
  CONCLUSIONS
  Our results suggest that preservation of the pyloric ring without vagal innervation has little significance, and that SSPPD with better perioperative and long-term outcomes is more suitable as a standard procedure for patients with pancreatic head cancer.
authors: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan. fjt@med.nagoya-u.ac.jp
authors: Tsutomu
authors: T
authors: Fujii
authors: Mitsuro
authors: M
authors: Kanda
authors: Yasuhiro
authors: Y
authors: Kodera
authors: Shunji
authors: S
authors: Nagai
authors: Tevfik T
authors: TT
authors: Sahin
authors: Masamichi
authors: M
authors: Hayashi
authors: Akiyuki
authors: A
authors: Kanzaki
authors: Suguru
authors: S
authors: Yamada
authors: Hiroyuki
authors: H
authors: Sugimoto
authors: Shuji
authors: S
authors: Nomoto
authors: Shin
authors: S
authors: Takeda
authors: Satoshi
authors: S
authors: Morita
authors: Akimasa
authors: A
authors: Nakao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018267:Carcinoma, Acinar Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000556:secondary / Q000601:surgery; D002291:Carcinoma, Papillary / Q000401:mortality / Q000556:secondary / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005746:Gastric Emptying; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011379:Prognosis; D011708:Pylorus; D012189:Retrospective Studies; D015996:Survival Rate