Pylorus-preserving pancreatoduodenectomy: technique and indications

Pylorus-preserving pancreatoduodenectomy is accepted as definitive treatment of some malignancies, such as cancer of the duodenal papilla, and cancer of the lower bile duct. However, its use in cancer of the head of the pancreas is controversial. We have applied pylorus-preserving pancreatoduodenectomy combined with extended lymph node dissection as the major technique in cases of malignant disease. Also, when invasion of the portal vein is confirmed or suspected, portal vein resection has been combined. However, when the duodenal bulb or pyloric ring has been invaded by cancer, the classic Whipple operation has been indicated. Our experience over the last 11 years has demonstrated no statistical difference in the 5-year survival rate between patients with pancreatic head cancer treated with the Whipple procedure (n = 25, 34.8%) and pylorus-preserving pancreatoduodenectomy (n = 16, 33.3%). Also, the postoperative quality of life proved to be better in patients with pylorus-preserving pancreatoduodenectomy. These data support the continued application of pylorus-preserving pancreatoduodenectomy for the treatment of cancer of the head of the pancreas.