Outcomes of Pylorus-Preserving Pancreaticoduodenectomy  for Periampullary Carcinoma in a Hepatobiliary Unit of A Military Hospita

Muhammad Umar Siddique; Nasir Mehmud Wattoo; Hira; Tayyaba Mushtaq Khan; Syed Daood Hashmi; Adil Maqbool

doi:10.51253/pafmj.v76i6.11960

Authors

Muhammad Umar Siddique Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Nasir Mehmud Wattoo Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Hira Department of Radiology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Tayyaba Mushtaq Khan Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Syed Daood Hashmi Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Adil Maqbool Department of Surgery, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i6.11960

Keywords:

Complications, Mortality, Outcome, Periampullary Carcinoma, Pylorus-preserving pancreaticoduodenectomy, Whipple procedure

Abstract

Objective: To evaluate the outcome of pylorus-preserving pancreaticoduodenectomy for periampullary carcinoma in the hepatobiliary unit.

Study Design: Prospective analytical study

Place and Duration of study: Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from Jun 23 to Feb 24

Methodology: Fifty-five consecutive patients with periampullary carcinoma underwent PPPD or Whipple procedure. A non-probability consecutive sampling technique was applied. Data were collected on the patients' demographics, intraoperative factors, pathology, and postoperative outcomes, including blood loss, hospital stay, complications, mortality, and weight changes.

Results: Of the 55 patients, 58.18% were male. Their mean preoperative weight was 70.07+ 7.91 kg, and their mean age was 59.32 + 7.03 years. Groups A and B had substantially different intraoperative blood loss (p< 0.05) and procedure durations (244.28 ± 44.59 ml; 337.86 ± 32.92min) and 351.48 ± 48.57ml; 342.22+49.33 min). Relaparotomy, delayed stomach emptying, and positive resection margins were among the post-surgery complications rates that did not significantly differ between groups (p> 0.05). Group-A's mortality rate was 17.8%, whereas Group-B's was 11.11% (p = 0.478).

Conclusion: Our findings suggest that, in cases with periampullary malignancy, pylorus-preserving pancreaticoduodenectomy is a preferable option to the Whipple approach, since it minimizes perioperative problems and enhances postoperative quality of life. To improve surgical methods and patient selection, further research is required.

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References

1. Uijterwijk B, Ghidini M, Wilmink H, Zaniboni A, Salvia R, Fusai GK, et al. The five periampullary cancers, not just different siblings but different families: an international multicenter cohort study. Eur J Surg Oncol 2024; 50(2): 107293.

https://doi.org/10.1016/j.ejso.2023.107293

2. Calderon E, Day RW, Stucky CC, Gray RJ, Pockaj BA, Chang YH, et al. Comparative effectiveness of pylorus-preserving versus standard pancreaticoduodenectomy in clinical practice. Pancreas 2020; 49(4): 568-573.

https://doi.org/10.1097/MPA.0000000000001529

3. Changazi SH, Ahmed Q, Bhatti S, Siddique S, Raffay EA, Farooka MW, et al. Whipple procedure: a five-year clinical experience in a tertiary care center. Cureus 2020; 12(11): e11467.

https://doi.org/10.7759/cureus.11467

4. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935; 102(4): 763-779. https://doi.org/10.1097/00000658-193510000-00023

5. Tian R, Qin RY. Pylorus-preserving pancreatoduodenectomy. In: Qin R, editor. Surgical Atlas of Pancreatic Cancer. Singapore: Springer; 2020: p. 33-38.

https://doi.org/10.1007/978-981-15-4222-0_5

6. Morelli L, Di Franco G, Furbetta N, Palmeri M, Guadagni S, Gianardi D, et al. Delayed gastric emptying after pylorus-preserving pancreatoduodenectomy: comparison between traditional open surgery and full-robotic approach with da Vinci Xi. Int J Med Robot 2023; 19(6): e2571. https://doi.org/10.1002/rcs.2571

7. Ahmed S, Yassein TE, Ashraf RE, Ahmed NS. Incidence and management of delayed gastric emptying after pylorus-preserving pancreatoduodenectomy in management of periampullary cancer: a single center study. Med J Cairo Univ 2022; 90(9): 1643-1654.

https://doi.org/10.21608/mjcu.2022.281896

8. Kim YJ, Shin SH, Han IW, Ryu Y, Kim N, Choi DW, et al. Clinical outcomes of pancreaticoduodenectomy for pancreatic ductal adenocarcinoma depending on preservation or resection of pylorus. Ann Hepato-Biliary-Pancreat Surg 2020; 24(3): 269-276. https://doi.org/10.14701/ahbps.2020.24.3.269

9. Busquets J, Martín S, Secanella L, Sorribas M, Cornellà N, Altet J, et al. Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD). Langenbecks Arch Surg 2022; 407(6): 2247-2258. https://doi.org/10.1007/s00423-022-02558-y

10. Probst P, Klaiber U, Seide S, Kawai M, Matsumoto I, Strobel O, et al. Individual patient data meta-analysis of delayed gastric emptying after pylorus-preserving versus pylorus-resecting pancreatoduodenectomy. Br J Surg 2021; 108(Suppl 4): znab202.030. https://doi.org/10.1093/bjs/znab202.030

11. Gady E. Pylorus-Preserving vs. Standard Pancreatoduodenectomy: A Systematic Review of Outcomes.

12. Mahrokhi S, Sakowitz S, Aguayo E, Justo M, Kropp R, Ali K, et al. Association of pylorus preservation with outcomes of pancreaticoduodenectomy across the United States. Surg Open Sci 2025; 28: 36-42. https://doi.org/10.1016/j.sopen.2025.10.005

13. Arjunan R, Karthik SDS, Chowdappa R, Althaf S, Srinivas C. Contemporary surgical, oncological, and survival outcomes of pancreaticoduodenectomy for periampullary tumours: a 5-year experience from tertiary cancer center. Indian J Surg Oncol 2021; 12(3): 603-610. https://doi.org/10.1007/s13193-021-01385-7

14. Maharjan N, Bhandari RS, Lakhey PJ. Predictive factors associated with survival in periampullary cancers following pancreaticoduodenectomy: a retrospective analysis. Cureus 2023; 15(12): e50607. https://doi.org/10.7759/cureus.50607.

15. Kumar S, Noushad N, Viswanathan MP, Raj A. Surgical outcomes and survival in pancreatic and periampullary cancers: a single centre experience. Indian J Surg Oncol 2025; 16(2): 621-626. https://doi.org/10.1007/s13193-024-02116-4

16. Ong BDC, Goh WJWH, Tan MMT, Loke S, Kan JRY, Yeo JKW, et al. Does minimally invasive pylorus-preserving pancreaticoduodenectomy (MI-PPPD) triumph over open pylorus-preserving pancreaticoduodenectomy (O-PPPD)? A systematic review and meta-analysis. Int J Surg 2026; 112(4): 10603-10611.

https://doi.org/10.1097/JS9.0000000000004734

17. Justo Alonso I, Marcacuzco Quinto A, Caso Maestro O, Alonso Murillo L, Rioja Conde P, Fernández Fernández C, et al. Whipple's cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy: retrospective study. Cir Esp 2024; 102(5): 265-274.

https://doi.org/10.1016/j.cireng.2024.02.007

18. Oh MH, Seo HI, Park YM, Noh BG, Song SB. Pancreaticoduodenectomy for second periampullary cancer following curative resection of extrahepatic bile duct cancer. Ann Hepatobiliary Pancreat Surg 2026; 30(1): 52-57. https://doi.org/10.14701/ahbps.25-164