The role of pancreaticoduodenectomy in the treatment of severe chronic pancreatitis

Chronic pancreatitis remains a debilitating disease with few definitive opt ions for treatment. The purpose of this study was to evaluate the benefit o f pancreaticoduodenectomy in the treatment of chronic pancreatitis, The res ults were evaluated by standard descriptive statistics. In a retrospective study, we reviewed the patients at a single institution undergoing pancreat icoduodenectomy between 1994 and 1997 for complications of chronic pancreat itis. Patients were evaluated for preoperative indication for surgery and p erioperative morbidity and mortality, as well as long-term results. Thirty- two patients underwent pancreaticoduodenectomy for chronic pancreatitis; 56 per cent (18) underwent pylorus-preserving and 44 per cent (14) underwent classic pancreaticoduodenectomy, The mean age of these patients was 56 +/- 14.7 years (range, 23-79). All patients underwent preoperative CT scan and endoscopic retrograde cholangiopancreatography. The preoperative indication for surgery in 81 per cent (26) of these patients was intractable pain in the setting of a nondilated pancreatic duct. The other 19 per cent were tre ated for biliary/pancreatic duct structure and pancreatic head fibrosis (ma ss suspicious of malignancy), Fifty-three per cent of the patients had a hi story of previous abdominal surgery. There were no perioperative deaths. Th e mean postoperative stay was 12.2 +/- 7.4 days. The postoperative morbidit y rate was 31 per cent (10), consisting of 25 per cent with delayed gastric emptying, 3 per cent with pneumonia, and 3 per cent with wound infections. There was no occurrence of pancreatic fistulas. With a mean follow-up of 4 0 months (range, 10-52 months), 85 per cent reported a significant improvem ent in pain with 71 per cent being pain free and not requiring narcotics. T wenty per cent developed new-onset diabetes. The overall event survival rat e at 5 years was 97 per cent. Thus, in a selected group of patients with se vere chronic pancreatitis, resection of the head of the pancreas achieved r elief of symptoms and was a safe and effective treatment for chronic pancre atitis.