Comparison of the functional outcome after pylorus-preserving pancreatoduodenectomy: pancreatogastrostomy and pancreatojejunostomy.

Abstract

To determine if there is any difference in pancreatic function after pylorus-preserving pancreatoduodenectomy(PPPD) according to the type of pancreatoenterostomy [pancreatojejunostomy (P-J) or pancreatogastrostomy (P-G)], we evaluated the long-term functional status of 34 patients who underwent PPPD and survived for more than 1 year without clinical evidence of recurrence. Altogether 20 patients underwent P-J and 14 P-G. To compare the two groups, we analyzed the (1) general nutritional status; (2) quality of life using three scoring systems; (3) gastrointestinal symptoms; and (4) pancreatic exocrine function by the stool elastase I test and endocrine function by oral glucose tolerance test (GTT). After PPPD, body weight decreased in both groups, with no difference between the two groups. No statistical differences were found in triceps skinfold thickness or serum protein/albumin. Regarding the quality of life and postoperative gastrointestinal symptoms, there were no differences between the two groups except steatorrhea. There were 4 mild and 15 severe cases of pancreatic exocrine insufficiency among those who underwent P-J, whereas all of the patients who underwent P-G showed severe pancreatic insufficiency. On GTT, excluding preoperative diabetes patients, 43.8% (7/16) of the P-J group had abnormal results after surgery, whereas 75.0% (9/12) of the PG group had an abnormal postoperative GTT (p = 0.11). Severe exocrine and endocrine pancreatic insufficiency developed after PPPD in both the P-J and P-G groups, but there was more functional deterioration in the P-G group than in the P-J group. General nutritional status and quality of life were not affected by the pancreatoenterostomy method in either group.