title: A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status.
abstract: OBJECTIVE
  Pylorus-preserving pancreatoduodenectomy (PPPD) has been associated with a high incidence of delayed gastric emptying (DGE). There are few studies comparing DGE associated with PPPD and subtotal stomach-preserving pancreatoduodenectomy (SSPPD). Moreover, differences between the procedures with respect to long-term results have not been reported. A prospective randomized study was conducted to compare perioperative complications and long-term nutritional status with PPPD and SSPPD.
  
  
  METHODS
  One hundred patients with periampullary lesions were randomized to receive either PPPD (n = 50) or SSPPD (n = 50). All patients were followed up for 3 years after surgery or to the time of recurrence to evaluate nutritional status for the study. The effects of the procedure, age, and malignancy on changes in nutritional indicators were estimated with linear mixed models. This study was registered at UMIN Clinical Trials Registry (UMIN 000012337).
  
  
  RESULTS
  The incidence of DGE assessed by the International Study Group of Pancreatic Surgery was 20% with PPPD and 12% with SSPPD (P = 0.414). There were no significant differences between the two procedures on postoperative serum albumin levels, serum total cholesterol levels, and body mass index during the 3-year follow-up period.
  
  
  CONCLUSIONS
  SSPPD is equally effective in DGE occurrence rate and long-term nutritional status comparing to PPPD.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Shinzeki
authors.forename: Sadaki
authors.initials: S
authors.lastname: Asari
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Goto
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Shirakawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000601:surgery; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies
keywords: delayed gastric emptying; long-term nutritional status; pylorus-preserving pancreatoduodenectomy; randomized controlled trial; subtotal stomach-preserving pancreatoduodenectomy