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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2012

01-01-2012 | Pancreatic Tumors

Preservation of the Pyloric Ring Has Little Value in Surgery for Pancreatic Head Cancer: A Comparative Study Comparing Three Surgical Procedures

Authors: Tsutomu Fujii, MD, PhD, FACS, Mitsuro Kanda, MD, PhD, Yasuhiro Kodera, MD, PhD, FACS, Shunji Nagai, MD, PhD, Tevfik T. Sahin, MD, Masamichi Hayashi, MD, Akiyuki Kanzaki, MD, Suguru Yamada, MD, PhD, Hiroyuki Sugimoto, MD, PhD, Shuji Nomoto, MD, PhD, Shin Takeda, MD, PhD, Satoshi Morita, PhD, Akimasa Nakao, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 1/2012

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Abstract

Background

Pylorus-preserving pancreatoduodenectomy (PPPD) has replaced conventional pancreatoduodenectomy with a distal gastrectomy (cPD) as the most commonly performed procedure. However, there has been no evidence from prospective studies to indicate the overwhelming superiority of PPPD over cPD. A recent report revealed that resection of the pyloric ring reduced the incidence of delayed gastric emptying (DGE) in a randomized controlled trial.

Methods

In 158 patients with pancreatic head cancer, the perioperative outcomes and long-term nutritional consequences were retrospectively compared among three types of pancreatoduodenectomy: cPD; PPPD; and subtotal stomach-preserving pancreatoduodenectomy (SSPPD), in which the pyloric ring and duodenum were removed and more than 90% of the stomach was preserved.

Results

The incidence of DGE was significantly higher in the PPPD group than in the cPD and SSPPD groups (27.3 vs. 5.8 and 5.4%, respectively; P = 0.0012). The serum albumin concentration and total lymphocyte count at 1 year postoperatively were significantly higher in the SSPPD group than in the PPPD group (P = 0.0303 and P = 0.0203, respectively). The patients in the SSPPD group showed longer survival times than the patients in the cPD and PPPD groups (median survival times, 21.3, 17.1, and 17.7 months, respectively), although the differences did not reach statistical significance.

Conclusions

Our results suggest that preservation of the pyloric ring without vagal innervation has little significance, and that SSPPD with better perioperative and long-term outcomes is more suitable as a standard procedure for patients with pancreatic head cancer.
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Metadata
Title
Preservation of the Pyloric Ring Has Little Value in Surgery for Pancreatic Head Cancer: A Comparative Study Comparing Three Surgical Procedures
Authors
Tsutomu Fujii, MD, PhD, FACS
Mitsuro Kanda, MD, PhD
Yasuhiro Kodera, MD, PhD, FACS
Shunji Nagai, MD, PhD
Tevfik T. Sahin, MD
Masamichi Hayashi, MD
Akiyuki Kanzaki, MD
Suguru Yamada, MD, PhD
Hiroyuki Sugimoto, MD, PhD
Shuji Nomoto, MD, PhD
Shin Takeda, MD, PhD
Satoshi Morita, PhD
Akimasa Nakao, MD, PhD, FACS
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1901-2

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