Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):269-276. 10.14701/ahbps.2020.24.3.269.

Clinical outcomes of pancreaticoduodenectomy for pancreatic ductal adenocarcinoma depending on preservation or resection of pylorus

• Kim YJ
• Shin SH
• Han IW
• Ryu Y
• Kim N
• Choi DW
• Heo JS

• KMID: 2505339
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.269

Abstract

Backgrounds/Aims
The comparative effectiveness of pylorus-resecting pancreaticoduodenectomy (PRPD) and pylorus-preserving pancreaticoduodenectomy (PPPD) in pancreatic head cancer is still disputed. The aim of this study was to analyze the data obtained from a large, single center with PPPD compared with PRPD in terms of postoperative outcomes, including blood glucose levels and survival in patients with pancreatic head cancer.
Methods
Between January 2007 and December 2016, a total of 556 patients with pancreatic head cancer underwent either PPPD or PRPD. We analyzed the clinicopathologic data to assess short- and long-term outcomes retrospectively.
Results
For underlying disease, patients with DM in PPPD were fewer than in PRPD (33.0% vs. 46.2%, p=0.002). The median value of CA19-9 was significantly higher in PRPD than in PPPD (129.36 vs. 86.47, p=0.037). The incidence of Clavien-Dindo grade III to V major complications in PPPD was significantly higher than in PRPD (20.4% vs. 13.4%, p=0.032). Resection of pylorus was shown to reduce complications in univariate and multivariate analyses (p=0.032 and = 0.021, respectively). The 5-year survival rates were 27.6% in the PPPD group and 22.4% in the PRPD group (p=0.015).
Conclusions
The results of PPPD and PRPD showed no significant differences from those reported conventionally in previous studies. Although further well-designed studies are needed, it is more important to select the range of surgical resection for the patient’s disease regardless of resection of pylorus.

Keyword

Pancreaticoduodenectomy; Pylorus-preserving pancreaticoduodenectomy; Pylorus-resecting pancreaticoduodenectomy; Pancreatic cancer

Figure

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  Fig. 1 Overall survival of pylorus-preserving and pylorus-resecting pancreaticoduodenectomy. The 5-year survival rates were 27.6% and 22.4% in pylorus-preserving and pylorus-resecting pancreaticoduodenectomy, respectively (p=0.015).

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  Fig. 2 Disease-free survival (DFS) of pylorus-preserving and pylorus-resecting pancreaticoduodenectomy. The 5-year DFS rates were 16.6% and 20.4% in pylorus-preserving and pylorus-resecting pancreaticoduodenectomy, respectively (p=0.952).

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