Die Wertigkeit der pyloruserhaltenden partiellen Duodenopankreatektomie beim duktalen Pankreascarcinom

Schoenberg, M. H.; Gansauge, Frank; Kunz, R.

doi:10.1007/s001040050356

Cited by 13 publications

(20 citation statements)

References 14 publications

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“…The effect of preservation of the pylorus on DGE following pancreatic resection is an ongoing controversy in the surgical literature. Some studies reported a higher incidence of DGE pylorus preservation whereas other authors did not [12, 15, 16, 17, 18, 19, 20, 33, 34, 35]. Consistent with more recent published studies, we did not observe an increased incidence of DGE after preservation of the pylorus [15, 20, 25, 36, 37].…”

Section: Discussionsupporting

confidence: 81%

“…It has been postulated that the ppWhipple procedure improves postoperative nutritional recovery and therefore benefits quality of life [12, 16, 17, 18, 19, 20, 28]. At our institution, we favor the pylorus-preserving Whipple resection although at present unbiased scientific evidence is lacking to prove the superiority of either type of resection.…”

Section: Discussionmentioning

confidence: 88%

“…Several studies have reported that preservation of the pylorus for pancreatic head resection (ppWhipple) has a similar morbidity and long-term survival compared to the classical Whipple resection (cWhipple) [12, 16, 17, 18, 19, 20]. It has been postulated that the ppWhipple procedure improves postoperative nutritional recovery and therefore benefits quality of life [12, 16, 17, 18, 19, 20, 28].…”

Section: Discussionmentioning

confidence: 99%

“…Several mostly retrospective studies have shown that preservation of the pylorus does not increase postoperative morbidity and mortality when compared with the cWhipple procedure [12, 15, 16, 17, 18, 19, 20]. Moreover, long-term survival was similar after the two procedures in all these studies with the exception of one rather small retrospective series [12, 15, 16, 17, 18, 19, 20]. Therefore, pylorus-preserving pancreatoduodenectomy is now considered a valid alternative to the classical Whipple procedure for the treatment of all forms of pancreatic and ampullary cancers.…”

Section: Introductionmentioning

confidence: 99%

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Pylorus-Preserving Total Pancreatectomy

Wagner¹,

Z’graggen²,

Vagianos³

et al. 2001

Dig Surg

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Background/Aims: Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse. Methods: A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99. Results: 11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5–66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus. Conclusion: Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pylorus-Preserving Total Pancreatectomy

Wagner¹,

Z’graggen²,

Vagianos³

et al. 2001

Dig Surg

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“…When comparing pylorus-preserving PD and classic Whipple procedure with regard to postoperative morbidity and survival, results from non-randomized studies are highly inconclusive (24)(25)(26)(27)(28)(29)(30). With the growing recognition of evidence-based surgery, randomized controlled trials (RCTs) comparing both procedures emerged, followed by systematic reviews and meta-analyses summarizing the existing literature (31)(32)(33).…”

Section: Postoperative Morbidity Mortality and Survivalmentioning

confidence: 99%

Pylorus preservation pancreatectomy or not

Klaiber

Probst

Büchler

et al. 2017

Transl. Gastroenterol. Hepatol.

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Pancreaticoduodenectomy (PD) is the treatment of choice for various benign and malignant tumors of the pancreatic head or the periampullary region, and the only hope for cure in patients with cancer at this side. While it has been associated with high morbidity and mortality rates in the last century, its centralization in specialized institutions together with refinements in the operative technique and better management of postoperative complications have made PD a standardized, safe procedure. Besides the classic Whipple procedure including distal gastrectomy, two variations of PD with or without pylorus resection, but preservation of the entire stomach in either procedure exist today. Pylorus-preserving PD has gained wide acceptance as standard procedure and is being performed by an increasing number of pancreatic surgeons.After its oncological adequacy was questioned initially, pylorus-preserving PD was shown to be equivalent to the classic Whipple procedure regarding tumor recurrence and long-term survival. Moreover, operation time and blood loss were shown to be reduced in the pylorus-preserving procedure and benefits in nutritional status and quality of life were observed. However, preservation of the pylorus has been suggested to result in an increased incidence of postoperative delayed gastric emptying (DGE). In this context, pylorus-resecting PD has become popular especially in Japan with the aim to prevent DGE by removal of the pylorus but preservation of the stomach. In contrast to positive results from early studies, latest high-quality randomized controlled trial (RCT) data show that pylorus resection does not reduce DGE compared to the pyloruspreserving operation. Non-superiority of pylorus resection was also confirmed in current meta-analysis on this topic. This article summarizes the existing evidence on PD with or without pylorus preservation and derives recommendations for daily practice.

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