| [ Summary ] |
Concern about poor quality of life following extended resection led us to adopt pylorus-preserving pancreatoduodenectomy (PpPD) for patients with cancer of the pancreatic head. The indication for PpPD was an intraoperative absence of detectable metastases to either the supra- or infrapyloric lymph nodes in patients who did not have tumorous invasion of the distal stomach or the first portion of the duodenum. We have consistently used PpPD with gastrointestinal recon-struction by implementing the Imanaga method (PpPD-Imanaga) , which entails an end-to-end duodenojejuno-stomy, end-to-side pancreatojejunostomy, and chole-dochojejunostomy, performed in that order. Our data indicate that PpPD-Imanaga, which simulates the normal anatomic arrangement, provides good performance status and satisfactory mixing of bile with food. We also performed distal pancreatectomy (DP) combined with resection of the celiac axis, which was involved in cancer of the pancreatic body. In such cases, most surgeons would combine total gastrectomy with DP because of the decreased blood supply to the stomach. In view of the poorer nutritional status caused by DP plus total gastrectomy, we tried to preserve the entire stomach with blood supply maintained via the inferior pancreatoduodenal artery. Extended lymph node dissection for treatment of pancreatic cancer has been performed in an effort to increase resectability and survival rates. However, the magnitude of this aggressive surgery causes poor nutritional status in many cases. Pylorus-preserving procedures can be a favorable complement to extended resection in maintaining good quality of life. |