PANCREATICODUODENECTOMY FOR BENIGN DISEASE

BACKGROUND: Surgeons are often called upon to perform pancreaticoduode nectomy for either suspicion of malignancy or symptoms due to benign d isease. Perioperative morbidity and mortality following pancreaticoduo denectomy have decreased markedly over the last 2 decades. In response , many surgical centers advocate expanding the indications for pancrea ticoduodenectomy to include lesions other than periampullary carcinoma . PATIENTS AND METHODS: A retrospective review of medical records for 108 patients undergoing pancreaticoduodenectomy for benign disease at The Johns Hopkins Medical Institutions over 100 months was completed. The subset of patients with a histopathologic diagnosis of chronic pan creatitis was identified and compared with patients undergoing pancrea ticoduodenectomy for other benign conditions. RESULTS: The mortality r ate for the present series was less than 1%. Perioperative complicatio ns, the majority of which were self-limited, occurred in 51% of patien ts. The most common complication was delayed gastric emptying. Pancrea tic anastamotic leak occurred in 18% of patients and developed signifi cantly more frequently in patients with benign diseases other than chr onic pancreatitis (31% versus 8%, P<0.05). CONCLUSION: Among appropria tely selected patients,the rates of perioperative mortality-and seriou s morbidity are low, and concerns about mortality and morbidity should not prevent an aggressive approach to surgical resection in patients with benign disease.