[Cephalic pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas: does pylorus preservation change morbidity and prognosis?].

STUDY AIM: To evaluate the influence of a pylorus-preserving on the morbidity and prognosis of patient with pancreaticoduodenectomy for adenocarcinoma of pancreas.

PATIENTS AND

METHODS

Between 1985 and 1999, 183 patients were operated on for pancreatic adenocarcinoma. Among them, 63 patients (40 men, mean age 63 years, range 41-77 years) had curative resection and were included in this retrospective study. They were classified according to the type of resection. In the group I, the procedure included a pylorus-preserving pancreaticoduodenectomy (n = 35). In the group II, the procedure included polar inferior gastrectomy (n = 28). The prognosis was compared. Parameters for comparison were rate of local recurrence, rate of metastatic evolution and duration of survival.

RESULTS

The operative length and mortality rate (group I: 0%, group II: 3%), general (p = 0.37) and specific morbidity (p = 0.30), frequency of delayed gastric emptying were similar in the 2 groups (group I: 20%, group II: 35%, p = 0.88). The duration of naso-gastic aspiration was shorter in the group I (6 days vs 8, p = 0.01). The prognosis was the same in the 2 groups (metastasis: group I: 39%, group II: 56%, p = 0.12, local recurrence: group I: 58%, group II: 43%, p = 0.09, mean survival: group I: 18 months, group II: 19 months, p = 0.77).

CONCLUSION

These results suggest that pylorus preserving pancreatoduodenectomy could be performed for patients with adenocarcinoma of the head of the pancreas and does not compromise survival.