Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease - A single-center 26-year experience

Objective To present preoperative and early postoperative data for 504 pati ents who underwent duodenum-preserving pancreatic head resection (DPPHR) fo r severe chronic pancreatitis (CP), Background The pancreatic head is considered to be the pacemaker of the dis ease in alcohol-induced CP, Indications for surgery in CP are intractable p ain and local complications. DPPHR offers the advantage of treating the com plications related to the inflammatory process in the head, relieving the p ain syndrome, and preserving the bilioduodenal anatomy, and ii may have the potential to change the natural course of chronic pancreatitis. Methods Between November 1972 and December 1998, 504 patients with chronic pancreatitis and an inflammatory mass in the pancreatic head were treated s urgically after medical pain treatment for a median of 3.6 years. The proce dure resulted in a hospital mortality rate of 0.8%. A continuous follow-up investigation lasting up to 26 years was conducted, during which the patien ts were reevaluated four times (1983, 1987, 1994, 1996). Between November 1 982 and October 1996, 388 patients treated surgically were reinvestigated t o evaluate the late outcome; the follow-up rate was 94% (25 patients were l ost to follow-up). The reinvestigation evaluation included glucose toleranc e test, exocrine pancreatic function test, pain status, physical status, pr ofessional and social rehabilitation, and quality of life, Results After an observation period of up to 14 years, 78.8% of the patient s were completely pain-free and 12.5% had (yearly) pain. 91.3% were conside red as pain-free; 8.7% had continuing abdominal pain; 12% had abdominal com plaints, During the 14 years of follow-up, only 9% were admitted to the hos pital for acute episodes of chronic pancreatitis. Endocrine function was im proved in 11%; in 21%, diabetes developed de novo. The rate of hospital adm ission for acute episodes decreased from 69% before surgery to 9% after sur gery, In the clinical management period of 9 years (median), the frequency of hospital admission dropped from 5.4 per patient before surgery to 2.7 af ter surgery. Fourteen years after surgery, 69% of the patients were profess ionally rehabilitated; in 72%, the quality of life index (Karnofsky criteri a) was 90 to 100 and in 18%, ii was <80. Conclusion In patients with alcoholic chronic pancreatitis in whom an infla mmatory mass has developed in the pancreatic head, DPPHR results in a chang e in the natural course of the disease in terms of pain status, frequency o f acute episodes, need for further hospital admission, late death, and qual ity of life.