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Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy
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Pylorus preservation pancreatectomy or not
Ulla Klaiber1, Pascal Probst1, Markus W Büchler1
1Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Translational Gastroenterology and Hepatology
|December 22, 2017
Summary
Pancreaticoduodenectomy (PD) with pylorus preservation is a safe and effective cancer treatment. Evidence shows pylorus resection does not reduce delayed gastric emptying and may not be superior to pylorus preservation.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Pancreaticoduodenectomy (PD) is a critical procedure for pancreatic head and periampullary tumors.
- Historically associated with high risks, PD is now safer due to centralization and improved techniques.
- Variations include pylorus-preserving and pylorus-resecting PD, with the former gaining acceptance.
Purpose of the Study:
- To review evidence comparing pylorus-preserving PD and pylorus-resecting PD.
- To evaluate the impact of pylorus preservation on oncological outcomes and postoperative complications.
- To provide recommendations for surgical practice regarding pylorus management in PD.
Main Methods:
- Systematic review of existing literature.
- Analysis of randomized controlled trials (RCTs) and meta-analyses.
- Comparison of outcomes between pylorus-preserving and pylorus-resecting PD.
Main Results:
- Pylorus-preserving PD demonstrates oncological equivalence to the classic Whipple procedure.
- Pylorus-preserving PD shows reduced operative time, blood loss, and improved nutritional status.
- High-quality RCTs and meta-analyses indicate pylorus resection does not decrease delayed gastric emptying (DGE) compared to preservation.
Conclusions:
- Pylorus-preserving PD is oncologically sound and offers patient benefits.
- Pylorus resection is not superior to pylorus preservation in preventing DGE.
- Current evidence supports pylorus-preserving PD as a standard procedure, challenging the rationale for routine pylorus resection.
