Comparative Effectiveness of Pylorus-Preserving Versus Standard Pancreaticoduodenectomy in Clinical Practice.
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal
/ mortality
Combined Modality Therapy
Confounding Factors, Epidemiologic
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Length of Stay
/ statistics & numerical data
Lymph Node Excision
Lymphatic Metastasis
Male
Middle Aged
Organ Sparing Treatments
/ methods
Pancreatic Neoplasms
/ mortality
Pancreaticoduodenectomy
/ methods
Pylorus
Retrospective Studies
Treatment Outcome
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
entrez:
14
4
2020
pubmed:
14
4
2020
medline:
15
5
2021
Statut:
ppublish
Résumé
We compared risk-adjusted short- and long-term outcomes between standard pancreaticoduodenectomy (SPD) and a pylorus-preserving pancreaticoduodenectomy (PPPD). The National Cancer Database was queried for the years 2004 to 2014 to identify patients with adenocarcinoma of the pancreatic head undergoing SPD and PPD. Margin status, lymph node yield, length of stay (LOS), 30- and 90-day mortality, and overall survival were compared. A total of 11,172 patients were identified, of whom 9332 (83.5%) underwent SPD and 1840 (16.5%) PPPD. There was no difference in patient age, sex, stage, tumor grade, radiation treatment, and chemotherapy treatment between the 2 groups. Total number of regional lymph nodes was examined, and surgical margin status and overall survival were also comparable. However, patients undergoing PPPD had a shorter LOS (11.3 vs 12.3 days, P < 0.001), lower 30-day mortality (2.5% vs 3.7%, P = 0.02), and 90-day mortality (5.5% vs 6.9%, P = 0.03). On multivariate analyses, patients undergoing SPD were at higher risk for 30-day mortality compared with PPPD (odds ratio, 1.51; 95% confidence interval, 1.07-2.13). Standard pancreaticoduodenectomy and PPPD are oncologically equivalent, yet PPPD is associated with a reduction in postoperative mortality and shorter LOS.
Identifiants
pubmed: 32282771
doi: 10.1097/MPA.0000000000001524
pii: 00006676-202004000-00012
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
568-573Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.
Saad AM, Turk T, Al Husseini MJ, et al. Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer. 2018;18:688.
Mbaidjol KZ, Burkhardt C, Malavallon B, et al. [Can the management and pronostic of pancreatic adenocarcinoma be improved ?]. [Article in French]. Rev Med Suisse. 2018;14:1237–1241.
Dumont R, Puleo F, Collignon J, et al. A single center experience in resectable pancreatic ductal adenocarcinoma: the limitations of the surgery-first approach. Critical review of the literature and proposals for practice update. Acta Gastroenterol Belg. 2017;80:451–461.
Modolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol. 1999;10(suppl 4):82–84.
Klimstra DS. Nonductal neoplasms of the pancreas. Mod Pathol. 2007;20:S94–S112.
Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med. 2014;371:1039–1049.
Lemke J, Schäfer D, Sander S, et al. Survival and prognostic factors in pancreatic and ampullary cancer. Anticancer Res. 2014;34:3011–3020.
Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530–536.
Yamamoto T, Yagi S, Kinoshita H, et al. Long-term survival after resection of pancreatic cancer: a single-center retrospective analysis. World J Gastroenterol. 2015;21:262–268.
Benassai G, Mastrorilli M, Quarto G, et al. Survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Chir Ital. 2000;5:263–270.
Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–15.
Huang L, Jansen L, Balavarca Y, et al. Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations. Gut. 2017;68:130–139.
Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15:1028–1061.
Trimble IR, Parson JW, Sherman CP. A one stage operation for the cure of carcinoma of the ampulla of Vater and the head of the pancreas. Surg Gynecol Obstet. 1941;73:711–722.
Whipple AO. The rationale of radical surgery for cancer of the pancreas and ampullary region. Ann Surg. 1941;114:612–615.
Watson K. Carcinoma of ampulla of vater successful radical resection. Br J Surg. 1944;31:368–373.
Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146:959–962.
Hüttner FJ, Fitzmaurice C, Schwarzer G, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2016;2:CD006053.
Yang C, Wu HS, Chen XL, et al. Pylorus-preserving versus pylorus-resecting pancreaticoduodenectomy for periampullary and pancreatic carcinoma: a meta-analysis. PLoS One. 2014;9:e90316.
Fujii T, Kanda M, Kodera Y, et al. Preservation of the pyloric ring has little value in surgery for pancreatic head cancer: a comparative study comparing three surgical procedures. Ann Surg Oncol. 2012;19:176–183.
Srinarmwong C, Luechakiettisak P, Prasitvilai W. Standard whipple's operation versus pylorus preserving pancreaticoduodenectomy: a randomized controlled trial study. J Med Assoc Thai. 2008;91:693–698.
Sharp KW, Ross CB, Halter SA, et al. Pancreatoduodenectomy with pyloric preservation for carcinoma of the pancreas: a cautionary note. Surgery. 1989;105:645–653.
Roder JD, Stein HJ, Hüttl W, et al. Pylorus-preserving versus standard pancreaticoduodenectomy: an analysis of 110 pancreatic and periampullary carcinomas. Br J Surg. 1992;79:152–155.
Wu W, Hong X, Fu L, et al. The effect of pylorus removal on delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of 2,599 patients. PLoS One. 2014;9:e108380.
Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–795.
Klinkenbijl JH, van der Schelling GP, Hop WC, et al. The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region. Ann Surg. 1992;216:142–145.
van Berge Henegouwen MI, van Gulik TM, DeWit LT, et al. Delayed gastric emptying after standard pancreaticoduodenectomy versus pylorus-preserving pancreaticoduodenectomy: an analysis of 200 consecutive patients. J Am Coll Surg. 1997;185:373–379.
Zhou Y, Lin L, Wu L, et al. A case-matched comparison and meta-analysis comparing pylorus-resecting pancreaticoduodenectomy with pylorus-preserving pancreaticoduodenectomy for the incidence of postoperative delayed gastric emptying. HPB (Oxford). 2015;17:337–343.
Karanicolas PJ, Davies E, Kunz R, et al. The pylorus: take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer. Ann Surg Oncol. 2007;14:1825–1834.
Sakamoto Y, Hori S, Oguro S, et al. Delayed gastric emptying after stapled versus hand-sewn anastomosis of duodenojejunostomy in pylorus-preserving pancreaticoduodenectomy: a randomized controlled trial. J Gastrointest Surg. 2016;20:595–603.
Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg. 1999;86:603–607.
Paraskevas KI, Avgerinos C, Manes C, et al. Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy: a review of the literature and critical reappraisal of the implicated pathomechanism. World J Gastroenterol. 2006;12:5951–5958.
Ogata Y, Hishinuma S. The impact of pylorus-preserving pancreatoduodenectomy on surgical treatment for cancer of the pancreatic head. J Hepatobiliary Pancreat Surg. 2002;9:223–232.
Huang W, Xiong JJ, Wan MH, et al. Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy. World J Gastroenterol. 2015;21:6361–6373.
Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–366; discussion 366–368.
Takao S, Aikou T, Shinchi H, et al. Comparison of relapse and long-term survival between pylorus-preserving and Whipple pancreaticoduodenectomy in periampullary cancer. Am J Surg. 1998;176:467–470.
Tran KT, Smeenk HG, van Eijck CH, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004;240:738–745.
Zhao R, Chang Y, Wang X, et al. Pylorus-preserving pancreaticoduodenectomy versus standard pancreaticoduodenectomy in the treatment of duodenal papilla carcinoma. Oncol Lett. 2018;15:6368–6376.