Comparison of Whipple's pancreaticoduodenectomy with the pylorus-preserving pancreaticoduodenectomy - a prospectively controlled, randomized long-term trial

The last decade's positive results of pancreaticoduodenectomy in the treatment of pancreatic and periampullary cancer have supported a rebirth of Whipple's operation. By the introduction of preservation of the gastric antrum and pylorus the operating risk has been reduced and the technique simplified. In many retrospective studies it could he demonstrated that both techniques yield the same results. However, this has not yet been proved in a prospectively controlled randomized study. Thus, our group has performed such a trial over a period of 10 years 23 patients were chosen for a Whipple and 17 for a pylorus-preserving pancreaticoduodenectomy and could be followed up for 12 years. There was no difference in morbidity, hospital mortality, and long-term survival. However, digestive and exocrine functions were better restored after the antral and pylorus preservation. Thus it could be shown that patients with pylorus-preserving pancreaticoduodenectomy had a better nutritional recovery and exocrine function. Furthermore, this operation can technically easier be performed.