Comparison of the Functional Outcome after Pylorus-preservingPancreatoduodenectomy: Pancreatogastrostomy and Pancreatojejunostomy

To determine if there is any differencein pancreatic function after pylorus-preserving pancreatoduodenectomy(PPPD) according to the type of pancreatoenterostomy[pancreatojejunostomy (P-J) or pancreatogastrostomy (P-G)], weevaluated the long-term functional status of 34 patients who underwentPPPD and survived for more than 1 year without clinical evidence ofrecurrence. Altogether 20 patients underwent P-J and 14 P-G. To comparethe two groups, we analyzed the (1) general nutritional status; (2)quality of life using three scoring systems; (3) gastrointestinalsymptoms; and (4) pancreatic exocrine function by the stool elastase Itest and endocrine function by oral glucose tolerance test (GTT). AfterPPPD, body weight decreased in both groups, with no difference betweenthe two groups. No statistical differences were found in tricepsskinfold thickness or serum protein/albumin. Regarding the quality oflife and postoperative gastrointestinal symptoms, there were nodifferences between the two groups except steatorrhea. There were 4mild and 15 severe cases of pancreatic exocrine insufficiency amongthose who underwent P-J, whereas all of the patients who underwent P-Gshowed severe pancreatic insufficiency. On GTT, excluding preoperativediabetes patients, 43.8% (7/16) of the P-J group had abnormal resultsafter surgery, whereas, 75.0% (9/12) of the PG group had an abnormalpostoperative GTT (p = 0.11). Severe exocrine andendocrine pancreatic insufficiency developed after PPPD in both the P-Jand P-G groups, but there was more functional deterioration in the P-Ggroup than in the P-J group. General nutritional status and quality oflife were not affected by the pancreatoenterostomy method in eithergroup.