Chronological change of total plasma ghrelin and D/A after pancreatoduodenectomy. (A) The perioperative ghrelin levels of patients who underwent SPD were significantly lower than that those who underwent PPPD or SSPPD. In patients with SPD, total ghrelin levels decreased significantly at 2 weeks after surgery. (B) Perioperative D/A decreased significantly at 6 months after surgery in SPD patients. *P<0.05 as indicated. D/A, desacyl ghrelin-to-acyl ghrelin ratio; SPD, standard pancreatoduodenectomy; PPPD, pylorus-preserving pancreatoduodenectomy; SSPPD, subtotal stomach-preserving pancreatoduodenectomy; Pre Ope, preoperative.