- Two main techniques are available in surgical treatment of cancer of the pancreatic head and (peri)ampullary carcinoma: Standard Whipple operation and pylorus-preserving pancreatoduodenectomy.
The standard technique resects the duodenum; pancreatic head; distal bile duct; gallbladder; distal half or two-thirds of the stomach; peripancreatic lymph nodes; and the lymph nodes at the hepatoduodenal ligament. Reconstruction is performed by pancreatojejunostomy or rarely by pancreatogastrostomy together with bilioenteric and gastrojejunal anastomosis. The main difference between the standard Whipple operation and the pylorus-preserving variant is that the latter technique preserves the entire stomach and a short postpyloric duodenal segment together with its neurovascular supply.
Since pancreatic cancer is known for its tendency to early lymphatogenous metastasis, it might be assumed that the pylorus-preserving technique without distal gastric resection and adjacent lymphadenectomy is not radical enough oncologically. On the other hand, the pylorus-sparing technique could be expected to improve gastrointestinal function and reduce morbidity.
A systematic review with metaanalysis of the endpoints survival, mortality and quality of life after pylorus-preserving or standard Whipple procedure published in 2010 included 23 studies with 3893 patients:
- Survival
There was no significant difference between the two surgical techniques. Thus, the pylorus-preserving technique achieves the same oncological efficacy (radicality) as the standard Whipple procedure. - Postoperative mortality
There was no significant difference between both techniques - Postoperative quality of life
Some studies described it either as not different or better after pylorus-preserving surgery.
- Survival
According to the available studies, as an organ-preserving procedure the pylorus-preserving pancreatoduodenectomy does not entail any adverse effects compared to the standard procedure. Benefits include the shorter operating time and the reduced intraoperative blood loss since there is no need for partial gastric resection.
Source: Fitzmaurice C, Seiler CM, Büchler MW, Diener MK. Survival, mortality and quality of life after pylorus-preserving or classical Whipple operation. A systematic review with meta-analysis. Chirurg. 2010 May;81(5):454-71.
Follow this link to the current German guideline: Cancer of the exocrine pancreas