Pylorus Ring Resection Reduces Delayed Gastric Emptying in Patients Undergoing Pancreatoduodenectomy A Prospective, Randomized, Controlled Trial of Pylorus-Resecting Versus Pylorus-Preserving Pancreatoduodenectomy

Objective: To determine in a prospective randomized controlled trial (RCT) whether pylorus-resecting pancreatoduodenectomy (PrPD) with preservation of nearly the entire stomach reduces the incidence of delayed gastric emptying (DGE) compared with pylorus-preserving pancreatoduodenectomy (PpPD). Background: Several RCTs have compared PpPD and conventional pancreatoduodenectomy with antrectomy. However, no study has reported the difference between PrPD with preservation of nearly the entire stomach and PpPD. Methods: One hundred thirty patients were randomized to preservation of the pylorus ring (PpPD) or to resection of the pylorus ring with preservation of nearly the entire stomach (PrPD). This RCT was registered at clinicaltrials.gov NCT00639314. Results: The incidence of DGE was 4.5% in PrPD and 17.2% in PpPD, a significant difference. Delayed gastric emptying was classified into 3 categories proposed by the International Study Group of Pancreatic Surgery. The proposed clinical grading classified 11 cases of DGE in PpPD into grades A (n = 6), B (n = 5), and C (n = 0) and one case in PrPD into each of the 3 grades. The time to peak (CO2)-C-13 content in the C-13-acetate breath test at 1, 3, and 6 months postoperatively was significantly delayed in PpPD compared with PrPD (34.3 +/- 24.6 minutes versus 18.7 +/- 11.8 minutes, 26.5 +/- 21.1 minutes versus 17.3 +/- 11.7 minutes, 26.7 +/- 18.8 minutes versus 17.4 +/- 13.2 minutes, respectively). Pylorus-resecting pancreatoduodenectomy and PpPD had comparable outcomes for quality of life, weight loss, and nutritional status during a 6-month follow-up period. Conclusion: Pylorus-resecting pancreatoduodenectomy significantly reduces of the incidence of DGE compared with PpPD.