Preservation of the Pyloric Ring Has Little Value in Surgery for Pancreatic Head Cancer: A Comparative Study Comparing Three Surgical Procedures

Fujii, Tsutomu; Kanda, Mitsuro; Kodera, Yasuhiro; Nagai, Shunji; Sahin, Tevfik Tolga; Hayashi, Masamichi; Kanzaki, Akiyuki; Yamada, Suguru; Sugimoto, Hiroyuki; Nomoto, Shuji; Takeda, Shin; Morita, Satoshi; Nakao, Akimasa

doi:10.1245/s10434-011-1901-2

Cited by 62 publications

(68 citation statements)

References 30 publications

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“…In the current study, we observed that the classic Whipple procedure was performed by 46.2% (24 surgeons), pylorus preserving by 28.8% (15), and SSPPD by 17.3% (nine). SSPPD is evolving worldwide, preserving the stomach and supporting the evidence that the pylorus is related to complications such as delayed gastric emptying, postoperative malnutrition at one year, and incomplete lymphadenectomy in up to 9.0% of patients 15,21,41 . Recently introduced in Brazil, SSPPD is gradually replacing the two previous procedures.…”

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 53%

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 99%

“…Fujii et al 15 observed that preservation of the pyloric ring has little value in surgery for pancreatic head cancer and when regional lymphadenectomy is necessary, SSPPD instead of PPPD might be recommended in order to reduce the incidence of postoperative DGE. In the current study, we observed that the classic Whipple procedure was performed by 46.2% (24 surgeons), pylorus preserving by 28.8% (15), and SSPPD by 17.3% (nine). SSPPD is evolving worldwide, preserving the stomach and supporting the evidence that the pylorus is related to complications such as delayed gastric emptying, postoperative malnutrition at one year, and incomplete lymphadenectomy in up to 9.0% of patients 15,21,41 .…”

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 99%

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Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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-Background: Pancreatoduodenectomy is a technically challenging surgical procedure with an incidence of postoperative complications ranging from 30% to 61%. The procedure requires a high level of experience, and to minimize surgery-related complications and mortality, a high-quality standard surgery is imperative. Aim: To understand the Brazilian practice patterns for pancreatoduodenectomy. Method: A questionnaire was designed to obtain an overview of the surgical practice in pancreatic cancer, specific training, and experience in pancreatoduodenectomy.

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Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 53%

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 99%

Section: Figure 3 -Pancreatic Anastomosis and Protection (A-d)mentioning

confidence: 99%

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Pancreatoduodenectomy: Brazilian practice patterns

Waechter¹,

Amaral²,

Costa³

et al. 2018

HPB

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“…Since then, several non-randomized and randomized trials on this topic have succeeded. Pylorus resection under preservation of the stomach has been shown to reduce DGE rate significantly in one RCT (43) and six non-randomized comparative trials (42,(44)(45)(46)(47)(48). In contrast, superiority of pylorus resection was not shown in four other comparative studies including two RCTs (49-52).…”

Section: Pylorus-preserving Versus Pylorus-resecting Pdmentioning

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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“…Gastric resection is avoided in the pylorus-preserving modification. Mortality and morbidity are not significantly different between both techniques [6] , but the pylorus-preserving procedure improve postoperative weight gain [7][8][9] . The majority of authors consider pancreatic anastomotic leakage as the primary cause of morbidity and mortality after PD [10][11][12][13] .…”

Section: Introductionmentioning

confidence: 98%

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

Morera-Ocón¹,

Sabater-Ortí²,

Muñoz-Forner³

et al. 2014

WJGO

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The pancreaticoduodenectomy (PD) procedure may lead to pancreatic exocrine and endocrine insufficiency. There are several types of reconstruction for this kind of operation. Pancreaticogastrostomy (PG) was introduced to reduce the rate of postoperative pancreatic fistula. Although some randomized control trials have shown no differences regarding pancreatic leakage between PG and pancreaticojejunostomy (PJ), recently some reports reveal benefits from the PG over the PJ. Some surgeons concern about the performing of the PG and inactivation of pancreatic enzymes being in contact with the gastric juice, and the detrimental results over the exocrine pancreatic function. The pancreatic exocrine function can be measured with direct and indirect tests. Direct tests have the highest sensitivity and specificity for detection of exocrine insufficiency but require tube placement. Among the tubeless indirect tests, the van de Kamer stool fat analysis remains the standard to diagnose fat malabsorption. The patient compliance and time consuming makes it not so suitable for its clinical use. Fecal immunoreactive elastase test is employed for screening of exocrine insufficiency, is not cumbersome, and has been used to study pancreatic function after resection. We analyze the FE1 levels in our patients after the PD with two types of reconstruction, PG and PJ, and we discuss some considerations about the pancreaticointestinal drainage method after pancreaticoduodenectomy. Core tip: Many patients present pancreatic exocrine insufficiency after pancreatic resection. Exocrine insufficiency leads to steatorrhoea, flatulence, abdominal pain, weight loss and malnutrition. Extent of resection will determine the severity of insufficiency, but also changes in anatomy may be determining factors. Pancreatogastrostomy is deemed detrimental over the pancreatic function because of the hypothetical inactivation of pancreatic enzymes due to the acid juice of the stomach. In this review we discuss the physiological aspects of the changes in exocrine pancreatic function focusing on the pancreatoenterostomy after a pancreaticoduodenectomy.Morera-Ocon FJ, Sabater-Orti L, Muñoz-Forner E, Pérez-Griera J, Ortega-Serrano J. Considerations on pancreatic exocrine function after pancreaticoduodenectomy. World J Gastrointest Oncol 2014; 6(9): 325-329 Available from:

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Preservation of the Pyloric Ring Has Little Value in Surgery for Pancreatic Head Cancer: A Comparative Study Comparing Three Surgical Procedures

Abstract: Our results suggest that preservation of the pyloric ring without vagal innervation has little significance, and that SSPPD with better perioperative and long-term outcomes is more suitable as a standard procedure for patients with pancreatic head cancer.

Cited by 62 publications

References 30 publications

Pancreatoduodenectomy: Brazilian practice patterns

Pancreatoduodenectomy: Brazilian practice patterns

Pylorus preservation pancreatectomy or not

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

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