Postobstructive chronic pancreatitis - Results with distal resection

Hypothesis: For most patients with chronic obstructive pancreatitis, distal pancreatectomy confers pain relief. Design: Retrospective case series. Follow-up was complete in 80% of study s ubjects (mean follow-up, 6.7 years). Setting: Tertiary care center. Patients: Among 484 patients with chronic pancreatitis undergoing operation from 1976 to 1997, 40 with postobstructive chronic pancreatitis were ident ified. Criteria for selection included an isolated, dominant major pancreat ic duct stricture or cutoff, changes of chronic pancreatitis in the distal pancreas, and ostensibly normal parenchyma without calcification in the pro ximal gland. The patients were reviewed with regard to operative procedure, postoperative course, and outcome. Main Outcome Measures: Outcome measures included degree of pain relief, mor bidity and mortality of operation, survival, rates of endocrine and exocrin e insufficiency, and ability to return to work and/or normal activities. Results: All but 1 of the 40 patients had abdominal pain, and 20 (50%) had recurrent episodes of acute pancreatitis. Suspicion of malignancy was a con cern in 16 patients (40%). Thirty-eight patients underwent distal pancreate ctomy; 1 had a central resection and another a Roux-en-Y cystojejunostomy. There was no operative mortality, but significant morbidity occurred in 15% . Among 31 patients with preoperative pain in whom long-term follow-up was available, complete or significant pain relief was achieved in 25 (81%); 74 % returned to normal social function, but about half had some element of pa ncreatic insufficiency. Conclusions: Distal pancreatectomy is a safe procedure and achieves pain re lief and good quality of life in a large percentage of patients (80%) with presumed postobstructive chronic pancreatitis. However, some of these patie nts with chronic pancreatitis involving the entire gland have disease masqu erading as postobstructive chronic pancreatitis secondary to an ostensibly isolated dominant pancreatic ductal stricture.