PYLORUS-PRESERVING PANCREATICODUODENECTOMY FOR CARCINOMA OF THE PANCREAS

Patients with carcinoma of the pancreas continue to be associated with a poor outcome, with surgical resection representing the only possibility of cure. The classic operation described by Whipple in 1935 has undergone many modifications with Traverso and Long-mire reintroducing preservation of the pylorus in an attempt to decrease the sequelae from the gastrectomy and improve nutritional outcome. Since 1979, the Lahey Clinic has performed pylorus-preserving pancreatoduodenectomy for the management of pancreatic and periampullary tumors as long as the duodenal margin is free of tumor and the antropyloric area appears viable. This article reviews the pattern of pancreatic tumor spread and the margins frequently involved with tumor. The management of distal biliary obstruction, our technique of pylorus-preserving pancreatoduodenectomy and our results of 106 pylorus-preserving pancreatoduodenectomies for pancreatic and periampullary carcinoma are discussed. We feel that pylorus-preserving pancreatoduodenectomy can achieve results as a cancer operation similar to the standard Whipple operation while eliminating the side effects related to gastric resection and improve the nutritional status of the patient. (C) 1995 Wiley-Liss, Inc.