Pylorus-preserving Whipple resection for pancreatic cancer. Is it any better?
A. G. Patel, M. T. Toyama, A. M. Kusske, P. Alexander, S. W. Ashley and H. A. Reber
Department of Surgery, Sepulveda Veterans Affairs Medical Center, Los Angeles, Calif., USA.
OBJECTIVE: To compare the short- and long-term morbidity and mortality
rates of the standard Whipple pancreatoduodenectomy (SW) and its
pylorus-preserving modification (PPW) in patients with malignant
periampullary disease. DESIGN: Retrospective medical record review and
quality of life assessment by telephone interview. SETTING: University
medical center. STUDY PARTICIPANTS: Sixty-seven patients who underwent
pancreatoduodenectomy (52 SW and 15 PPW) from June 1988 to January 1994.
INTERVENTION: The SW and PPW. MAIN OUTCOME MEASURES: Operative features and
short- and long-term complications were analyzed with respect to the type
and stage of cancer and the kind of pancreatic resection. Mean follow-up
was 32 months (range, 1 to 5 years). RESULTS: The operative mortality rate
for all patients who had a pancreatic resection was 1.5%. The diagnoses in
the PPW vs SW groups were pancreatic cancer (four vs 27 patients),
ampullary cancer (six vs seven patients), duodenal cancer (zero vs six
patients), and bile duct cancer (five vs one patient). Operative mortality
rates (0% vs 1.55%) and operative times (2 minutes longer for SW) were
similar. Delayed gastric emptying (61% vs 41%) was more common in the PPW
group, resulting in a longer hospitalization (24 vs 18 days) and a greater
cost in the PPW group (P = .04). In the PPW group, a mean of five lymph
nodes was removed compared with 10 in the SW group (P = .04). CONCLUSIONS:
The data provided no evidence of any advantage for the PPW in patients with
malignant periampullary tumors. We continue to advocate the SW for
pancreatic cancer.
