Outcome following pylorus resecting pancreaticoduodenectomy versus classical Whipple's pancreaticoduodenectomy: a randomised controlled trial.

Objective: To compare pylorus resecting pancreaticoduodenectomy (PRPD) with classical pancreaticoduodenectomy (classical PD) in terms of short term outcomes.

Background: There is some evidence that Pylorus resecting PD (PRPD) is associated with lesser incidence of DGE when compared to pylorus preserving PD (PPPD). However, no study has previously compared PRPD with classical PD.

Methods: Patients requiring PD were randomly assigned to either PRPD or classical PD after intraoperative assessment to rule out metastases and unresectable disease. Occurrence of DGE was the primary end point.

Results: A total of 154 patients (103 males; Mean age:53.3 ± 12.2 years) were included in the final analysis (PRPD = 78, classical PD = 76). PRPD group had significantly shorter operation [Mean difference: 41 min (95 % CI:18-65)]. There was no significant difference in the incidence of DGE [32 (41.0 %)vs37 (48.7 %); p = 0.339] and clinically significant DGE [22 (28.2 %)vs19 (25.0 %); p = 0.789] between PRPD and classical PD. There was also no difference in the rates of clinically relevant pancreatic fistula [20 (25.6 %)vs22 (28.9 %); p = 0.780], severe morbidity [21 (26.9 %)vs19 (25.0 %); p = 0.930], operative mortality [6 (7.7 %)vs2 (2.6 %); p = 0.157] and median postoperative stay [12 (5-47) days vs 12 (6-56) days; p = 0.861].

Conclusion: We found no significant difference in the early postoperative outcomes between PRPD and classical PD. PRPD was found to be significantly faster than the classical PD.