Short-term Outcome of Pylorus-preserving Pancreaticoduodenectomy for pancreatic carcinoma
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Objectives: To illustrate immediate and short-term outcome of pylorus-preserving pancreaticoduodenectomy (PPPD) as a surgical modality for patients had pancreatic carcinoma Patients & Methods: The study included 23 patients; 13 males and 10 females with mean age of 66.3±4 years. All patients underwent clinical evaluation, laboratory assessment and CT or MRI examination. Primary outcome measures included frequency of leakage, fistula, intra-abdominal tluid collection/abscess, delayed gastric emptying and/or postoperative bleeding. Secondary outcome measures included operation time, blood loss, required blood replacement, status of resection margins, number and status of removed lymph nodes, general morbidity, duration of ICU and postoperative (P0) hospital stay and PO overall mortality. Results: No intraoperative complications or mortality was recorded. Site of tumor origin was pancreatic in 15 patients and ampullary in 8 patients. Nine tumors were poorly differentiated. Mean tumor diameter was 2.4±0.4 cm. Surgical margin showed microscopic infiltration in two patients. Perineural and vascular invasions were detected in 13 and 10 patients, respectively. Seventeen patients had positive lymph node metastases in the resection specimen. Mean number of resected lymph nodes was 17±1.8. Mean ICU stay duration was 2.4±0.8 days. One patient developed acute myocardial infarction on the 2" PO day. The frequency of fistula development was 13.6%; one patient had intra-abdominal collection and underwent CT guided drainage. Four patients (18.2%) developed wound infection and 6 patients had delayed gastric emptying for total PO morbidity rate of 59.1%. Mean PO hospital stay was 10.6±1.9 days with an immediate PO survival rate of 95.7%. Mean duration of follow-up was 31.1±9.1 months with 2-year survival rate of 82.6%, 3-year survival rate of 39.1% and 4-year survival rate of 13%. Conclusion: PPPD could be considered as a safe, feasible and effective surgical modality for patients had pancreatic tumors with controllable PO morbidity and PO survival for >4 years in 13%.