Pancreatoduodenectomy for chronic pancreatitis - Long-term results in 105 patients

Hypothesis: For patients with head-dominant, small-duct chronic pancreatiti s who require operative intervention, pancreatoduodenectomy can be performe d safely and affords satisfactory pain relief in most. Design: Retrospective case series. Follow-up was complete in 86% of study s ubjects (average, 6.6 years). Setting: Tertiary care center. Patients: Among 484 consecutive cases of chronic pancreatitis treated surgi cally from January 1976 through April 1997, 105 (22%) in which pancreatoduo denectomy was performed were reviewed with regard to criteria for selection , operative procedure, postoperative course, and long-term outcome. Main Outcome Measures: The main outcome measure was degree of pain relief. Additionally, late mortality, cause of death, the presence of endocrine and exocrine insufficiency, and quality of life were recorded. Results: There were 72 men (69%) and 33 women (31%) with a mean age of 51 y ears (range, 24-77 years). The cause of chronic pancreatitis was alcohol re lated in 58 patients (55%) and idiopathic in 41 (39%). Clinical manifestati ons included abdominal pain in 86 patients (82%), obstructive jaundice in 2 7 (26%), and vomiting in 11 (11%). Suspicion of malignant neoplasm was a co ncern in 67 patients (64%). Operative morbidity was 32%, and mortality, 3%. Mean hospital stay was 16 days (range, 12-82 days). Survival was significa ntly lower than that of age-matched controls. Among 66 patients with preope rative pain, pain relief was achieved in 59 (89%); it was complete in 44 pa tients (67%) and partial in 15 (23%). Operation resulted in a significant i ncrease in patients with normal functional status (73 patients [81%] vs 51 [49%]; P<.001). Forty patients (48%) had diabetes; Steatorrhea was observed in 39 patients (43%), while weight maintenance or gain occurred in 59 (66% ). Conclusions: Pancreatoduodenectomy achieves pain relief and good quality of life in a large percentage of selected patients with small-duct, head-domi nant disease and is especially useful when a malignant neoplasm must be exc luded. Morbidity and mortality are acceptable in experienced hands. Onset o f diabetes and steatorrhea, while reflecting the natural course of the dise ase, is likely accelerated by pancreatoduodenectomy.