title: Classic Whipple versus pylorus-preserving pancreaticoduodenectomy in the ACS NSQIP.
abstract: BACKGROUND
  The classic Whipple operation carries substantial risk of complications. A pylorus-preserving pancreaticoduodenectomy might confer the benefit of decreased perioperative morbidity, but existing data comparing both techniques are inconclusive.
  
  
  METHODS
  Using a propensity score model to adjust for potentially confounding differences in patient characteristics, 30-d mortality, operative time, red blood cell transfusion requirements, major complications, and length of hospital stay were compared between both techniques in the American College of Surgeons' National Surgical Quality Improvement Program database. Separate analyses were carried out for underlying malignancy or benign disease, as defined by International Classification of Diseases, Ninth Revision codes.
  
  
  RESULTS
  A total of 6988 pancreaticoduodenectomies from 2005 through 2010 were included. In 5424 patients (77.6%) with underlying malignancy, there were no significant differences for 30-d mortality (2.4% versus 2.8%, P = 0.33) and major organ system complications (all P > 0.10). Patients undergoing the classic Whipple operation had a significantly longer operative time (389 versus 366 min, P < 0.01), longer length of hospital stay (13.1 versus 12.0 days, P < 0.01), and higher red blood cell transfusion requirements (1.0 versus 0.8 units, P < 0.01). Results were similar for 1564 patients (22.4%) with underlying benign disease, except for a higher occurrence of postoperative pulmonary (P = 0.02) and renal (P = 0.05) complications in patients undergoing the classic Whipple operation.
  
  
  CONCLUSIONS
  Short-term outcomes after classic and pylorus-preserving pancreaticoduodenectomy in this large, multicenter database are excellent, without significant differences in postoperative mortality and most major organ system complications. However, small advantages in resource and blood utilization may be accomplished with the pylorus-preserving technique.
authors: Department of Surgery, St Joseph Mercy Health System, Ann Arbor, Michigan 48106, USA. leichtls@trinity-health.org
authors: Stefan W
authors: SW
authors: Leichtle
authors: Christodoulos
authors: C
authors: Kaoutzanis
authors: Nicolas J
authors: NJ
authors: Mouawad
authors: Kathleen B
authors: KB
authors: Welch
authors: Richard
authors: R
authors: Lampman
authors: Verne L
authors: VL
authors: Hoshal
authors: Edward
authors: E
authors: Kreske
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012955:Societies, Medical; D016896:Treatment Outcome