Classic Whipple versus pylorus-preserving pancreaticoduodenectomy in the ACS NSQIP

Abstract Background The classic Whipple operation carries substantial risk of complications. A pylorus-preserving pancreaticoduodenectomy might confer the benefit of decreased perioperative morbidity, but existing data comparing both techniques are inconclusive. Methods Using a propensity score mode...

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Bibliographic Details
Published in:The Journal of surgical research 2013-07, Vol.183 (1), p.170-176
Main Authors: Leichtle, Stefan W., MD, Kaoutzanis, Christodoulos, MD, Mouawad, Nicolas J., MD, MRCS, Welch, Kathleen B., MPH, Lampman, Richard, PhD, Hoshal, Verne L., MD, Kreske, Edward, MD
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Aged
Databases, Factual
Female
Humans
Male
Middle Aged
NSQIP
Outcomes
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy - methods
Propensity-matched comparison
Pylorus-preserving pancreaticoduodenectomy
Societies, Medical
Surgery
Treatment Outcome
Whipple operation
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Summary:Abstract Background The classic Whipple operation carries substantial risk of complications. A pylorus-preserving pancreaticoduodenectomy might confer the benefit of decreased perioperative morbidity, but existing data comparing both techniques are inconclusive. Methods Using a propensity score model to adjust for potentially confounding differences in patient characteristics, 30-d mortality, operative time, red blood cell transfusion requirements, major complications, and length of hospital stay were compared between both techniques in the American College of Surgeons' National Surgical Quality Improvement Program database. Separate analyses were carried out for underlying malignancy or benign disease, as defined by International Classification of Diseases, Ninth Revision codes. Results A total of 6988 pancreaticoduodenectomies from 2005 through 2010 were included. In 5424 patients (77.6%) with underlying malignancy, there were no significant differences for 30-d mortality (2.4% versus 2.8%, P  = 0.33) and major organ system complications (all P  > 0.10). Patients undergoing the classic Whipple operation had a significantly longer operative time (389 versus 366 min, P  
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2013.01.016