The aim of this clinical analysis was to evaluate whether the pylorus-preserving pancreaticoduodenectomy (PPPD) is a safe and radical enough procedure for nonpancreatic periampullary carcinoma, without increasing the morbidity and mortality rates iin comparison to pancreaticoduodenectomy (PD: Standard Whipple procedure).
During the period January, 1991 to June. 1994, a PD of PPPD was performed in 84 patients with nonpancreactic periampullary carcinoma, at the Department of Surgery, Seoul National University College of Medicine. We separated the patients in to PPPD(n=38) and PD(n=46) groups according to the operation performed. There were no significant differences with respect to days of gastric suctioning, start of liquid fluid or resumption of normal diet. Postoperative morbidity including delayed gastric emptying(5.3%) as well as mortality was similar to that of PD. The type of resection had no influence on survival in patients with periampullary carcinoma which had a 1-year survival of 74.4% and 83.1% for PPPD
and PD. respectively. The 2-year survival was 58.0% after PPPD and 61.0% after PD. Tumor-containing duodenal resection margin was not detected. During follow-up, with a median duration of follow-up of 14 months, no difference was found with respect to cancer recurrence patterns. Weight change after operation during follow-up was relatively more favorable after PPPD. In conclusion, PPPD can be an alternative choice for PD in nonpancreatic periampullary cancer without compromising curability. No differences in morbidity and mortality rates existed between the to procedures. During follow-up, weight gain appears to be better after PPPD.
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