The Role of Pylorus-Preserving Duodenopancreatectomy in Pancreatic Cancer

Although the history of duodenopancreatectomy is very old there is still an ongoing discussion on whether the pylorus-preserving type of duodenopancreatectomy should be done in patients with cancer of the pancreatic head. Recent data convincingly show a trend to consider the pylorus-preserving type of duodenopancreatectomy in pancreatic cancer as an excellent alternative. Though the experience with pancreatic cancer disease is not yet conclusive, the fascinating benefit of the pylorus-preserving duodenopancreatectomy has result in a reduction of surgical trauma, a decrease of operating time, a reduction of blood loss and very importantly, optimal postoperative digestion and nutrition due to the preservation of the antrum pylorus unit, resulting in an overall improvement in quality of life compared to the standard Whipple procedure. Recent data show an equal survival rate and incidence of locoregional recurrences or distant metastasis with both types of operation. This phenomenon still needs to be confirmed since so far no randomised prospective study comparing the standard Whipple operation with pylorus-preserving duodenopancreatectomy in pancreatic cancer has been done.