Extended drainage versus resection in surgery for chronic pancreatitis - Aprospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy

Objective To analyze the efficacy of extended drainage-that is, longitudinal pancreat icojejunostomy combined with local pancreatic head excision (LPJ-LPHE)-and pylorus-preserving pancreatoduodenectomy (PPPD) in terms of pain relief, co ntrol of complications arising from adjacent organs, and quality of life. Summary Background Data Based on the hypotheses of pain origin (ductal hypertension and perineural inflammatory infiltration), drainage and resection constitute the main prin ciples of surgery for chronic pancreatitis, Methods Sixty-one patients were randomly allocated to either LPJ-LPHE (n = 31) or P PPD (n = 30). The interval between symptoms and surgery ranged from 12 mont hs to 10 years (mean 5.1 years). In addition to routine pancreatic diagnost ic workup, a multidimensional psychometric quality-of-life questionnaire an d a pain score were used. Endocrine and exocrine functions were assessed in terms of oral glucose tolerance and serum concentrations of insulin, C-pep tide, and HbA(1c), as well as fecal chymotrypsin and pancreolauryl testing. During a median follow-up of 24 months (range 12 to 36), patients were rea ssessed in the outpatient clinic. Results One patient died of cardiovascular failure in the LPJ-LPHE group (3.2%); th ere were no deaths in the PPPD group. Over ail, the rate of in-hospital com plications was 19.4% in the LPJ-LPHE group and 53.3% in the PPPD group, inc luding delayed gastric emptying in 9 of 30 patients (30%; p < 0.05). Compli cations of adjacent organs were definitively resolved in 93.5% in the LPJ-L PHE group and in 100% in the PPPD group. The pain score decreased by 94% af ter LPJ-LPHE and by 95% after PPPD. Global quality of life improved by 71% in the LPJ-LPHE group and by 43% in the PPPD group (p < 0.01). Conclusions Both procedures are equally effective in terms of pain relief and definitiv e control of complications affecting adjacent organs, but extended drainage by LPJ-LPHE provides a better quality of life.