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

  • 1Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea


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.
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.
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).
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.


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


  • 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).

  • 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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