Abstracts
1999 Digestive Disease Week

# 2200 RANDOMISED PROSPECTIVE TRIAL ON PYLORUS PRESERVING VERSUS CLASSIC DUODENOPANCREATECTOMY (WHIPPLE) IN PANCREATIC CANCER
Christian A Seiler, M Wagner, Ch. Sadowski, Univ Hosp of Berne, Berne Switzerland; M W Buchler, Univ of Bern, Berne Switzerland

For treatment of cancer in the pancreatic head, two resection procedures have been evolved during the last decades, the classic Whipple resection (cWhipple) and the pylorus-preserving Whipple) (ppWhipple) operation. However no definitive answer exists in the literature whether the more conservative ppWhipple indeed equalizes the short and long term results as well as quality of life of the cWhipple procedure. Material and Methods: We conducted a randomized prospective trial comparing morbidity and mortality as well as long-term results such as survival and quality of life in a nonselected, consecutive material. Patients demographics, clinical, laboratory, diagnostic, intraoperative (blood loss, OR-time) and histologic findings (tumor type and tumor stage) as well as medical and surgical complications were recorded and entered in a statistical database. After discharge, patients were seen at 3 month intervals and quality of life, weight course, ability to work and survival were analyzed. For statisical evaluation Cruskal-Wallis and chi-square tests were used where appropriate. For analysis of survival the Kaplan-Meyer Test was applied and differences were examined the the log-rank test. Results: From 6/96 to 10/98 89 patients with suspected malignancy of the pancreas or the periampullary region were prospectively randomized to undergo either a cWhipple or ppWhipple. Based on the intraoperative findings 64 patients presented a resectable malignancy and were entered in this study resulting in 33 patients undergoing cWhipple and 31 patients receiving a ppWhipple. There was no difference in patients demographic, OR-time, intraoperative blood loss, length of ICU- and in-hospital stay and early postoperative results. The incidence of temporary delayed gastric emptying was identical in both groups and was for cWhipple and ppWhipple 37% and 30% respectively (p >0.5). There was neither a significant difference concerning predisease weight and preoperative weight loss nor weight gain 3 and 6 month postoperatively. Furthermore, capability to work and self-judged quality of life was identical 3 and 6 months after resection in the two groups. However 12 months after ppWhipple, there was a significant better weight gain (80% versus 90% for cWhipple; p = 0.007). and improved quality of life (p = 0.003) but not ability to work. Conclusion: Our preliminary results demonstrate that cWhipple and ppWhipple for the treatment of pancreatic and periampullary cancer are no different concerning short term results, tumor recurrence and long-term survival and capability to work. However, there exists a significnt difference in long-term weight gain and quality of life, which seems to favor the ppWhipple procedure.

Copyright 1996 - 1999, SSAT, Inc.