Distal pancreatectomy in chronic pancreatitis

Background: The indications for a resective procedure in chronic pancreatit is are severe pain and local complications. The aim of this study, based on prospectively assessed data, was to evaluate distal pancreatectomy in pati ents suffering from chronic pancreatitis localized in the corpus and cauda of the pancreatic gland. Methods: Seventy-four patients undergoing distal p ancreatectomy were evaluated pre- and postoperatively (after a median obser vation period of 58 months) for pain, professional status, alcohol consumpt ion, and endocrine function as measured by the glucose tolerance test preop eratively. Results: The indication for operation was severe therapy-resista nt pain in nearly all patients and an inflammatory tumor or pancreatic pseu docysts in over 50% of the patients. One fourth of the patients were operat ed in order to exclude malignancy. Ninety-five percent of the patients unde rwent distal pancreatectomy, only in 4 cases (5%) was a subtotal (Child) re sective procedure performed. In 34% of patients undergoing distal pancreate ctomy a splenectomy could be avoided. The early postoperative complications were few and mostly due to the severe comorbidity of the patients. During the median observation period of 58 months 14.7% of the patients died due t o diseases not related to distal pancreatectomy. Six percent of the patient s could not be reevaluated and were lost to follow-up. In the remaining 59 patients 88% had significantly less pain and 66% had an increase in median body weight of 8 kg. Fifty percent of the patients had full or partial prof essional rehabilitation, one fourth was unemployed and 24% had retired due to age. 51.7% had a normal endocrine function as assessed by the glucose to lerance test, 16.2 and 21.6% had a latent or manifest diabetes mellitus, re spectively. In 74.5% of all patients the endocrine function did not worsen during the observation period. Conclusion: In comparison to conservative tr eatment distal pancreatectomy is a suitable therapeutic measure in patients with severe pain and local complications. It significantly improves the qu ality of life of patients without compromising endocrine function. Postoper ative lethality is lower than in conservatively treated patients and is not related to distal pancreatectomy.