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
fluid 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 (PO) 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 2nd 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%. |
