LONG-TERM RESULTS OF PYLORUS-PRESERVING PANCREATICODUODENECTOMY FOR CHRONIC-PANCREATITIS

Objective: To assess the long-term outcome of patients following pylor us-preserving pancreatoduodenectomy (PPPD) for chronic pancreatitis. D esign: Retrospective study with mean follow-up of 63 months (range, 1 month to 13.7 years). Setting: Tertiary referral hospital. Patients: R ecords of all patients who underwent PPPD for chronic pancreatitis at Lahey Clinic were reviewed. All patients who were alive were contacted by telephone. In cases where patients had died, information was gathe red from family members and hospital records. Results: Forty-five pati ents underwent PPPD for disabling chronic pancreatitis. The mean preop erative duration of pain was 50 months, with 32 patients (70%) requiri ng daily narcotics. In one patient resection of the portal vein was re quired. One patient died within 30 days of the operation. Forty-one pa tients (92%) had improvement of pain at 5 years. The mean pain score ( on a scale of 0 to 10) was 9.2 preoperatively and 1.5, 0.8, 1.1, and 1 .1 at 6 months, 1 year, 2 years, and 5 years, respectively. Thirty-thr ee patients (74%) had a postoperative weight gain to an average of 92% of their pre-illness weight. New-onset diabetes occurred in six patie nts (14%) by 6 months and in 21 patients (46%) by 5 years. Hypoglycemi a was the cause of death in one patient who underwent total pancreatec tomy. Four patients died of causes unrelated to PPPD. Marginal ulcers occurred in five patients (10%). Nine patients required late operation s.Conclusions: In selected patients, resection of the head of the panc reas achieves long-term pain improvement in over 90% of cases. The ear ly development of diabetes mellitus is infrequent, but over longer fol low-up periods it reaches prevalence rates similar to those described in patients who have not undergone resection. Weight gain in this grou p was superior to that previously reported for our patients who underw ent ''standard Whipple'' operation for chronic pancreatitis.