Long-term results after surgery for chronic pancreatitis

Aim. To determine the early and late morbidity and mortality after surgical treatment of chronic pancreatitis. Methods. We determined long-term outcome and early and late morbidity and m ortality, respectively, in 484 consecutive patients undergoing surgery for chronic pancreatitis from 1976 through 1997. Sixty-five percent of the pati ents had small duct disease (main pancreatic duct <7 mm), whereas 35% had l arge duct disease. Indications for operation were pain (95%), suspicion of malignancy (28%), and complications involving adjacent organs (35%). Pseudo cysts were present in 27% of patients. Hospital morbidity (8 vs 23%, p = 0. 0002) and mortality (0 vs 1.9%, p = 0.12) were less after drainage procedur es (n = 162) than after pancreatic resections (n = 286). Among resectional procedures, total pancreatectomy had the highest 30-d operative mortality ( 5%) and morbidity rates (47%), followed by pancreatoduodenectomy (3 and 32% , respectively). The best results with pain relief occurred after proximal pancreatic resection (89% after mean follow-up of 6.5 yr). The number of pa tients able to function normally after surgical treatment increased from 39 to 79% (p < 0.001). Long-term survival of our patients was lower than expe cted rates based on Minnesota life tables analysis (p < 0.0001) especially in alcoholics. Patients undergoing a ductal drainage procedure had the long est survival, whereas those after total pancreatectomy had the shortest sur vival (p = 0.06). Pancreatic insufficiency, peptic ulcer, and/or anastomoti c ulcers caused significant morbidity after total pancreatectomy and pancre atoduodenectomy. A small percentage (3%) developed pancreatic cancer. Conclusions. Operative treatment of chronic pancreatitis, when indicated, c an be performed safely with good results in terms of pain relief and qualit y of life. Resectional procedures (especially total pancreatectomy) are ass ociated with higher early and late morbidity, greater perioperative mortali ty, and lower survival rates compared with drainage procedures. Abstinence from alcohol is associated with longer survival rates, which, however, stil l remain lower than expected rates.