Duodenopancreatectomía cefálica tipo Whipple versus duodenopancreatectomía con preservación pilórica. Estudio retrospectivo

Abstract

IntroductionControversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric-preserving (PD-PP) or Whipple's technique (with antrectomy [PD-W]), the former being associated with a higher frequency of delayed gastric emptying (DGE). MethodsRetrospective and comparative study between PD-PP technique (n=124 patients) and PD-W technique (n=126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. ResultsSurgical time was longer, although not significant, with the PD-W technique. Pancreatic and peripancreatic tumor invasion (p=0.031) and number of lymph nodes resected (p<0.0001) reached statistical significance in PD-W, although there was no significant difference between the groups in terms of lymph node tumor invasion.Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien-Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. ConclusionsPostoperative morbidity and mortality and long-term survival were not significantly different with PD-PP and PD-W, but POPF grade B/C was a risk factor for DGE grade C.