Long-term results following different extent of resection in chronic pancreatitis

Background/Aims: To evaluate, whether the indication related varying extent of resection in chronic pancreatitis has a predictable impact on long-term outcome. Methodology: One hundred and twenty-six patients consecutively underwent su rgery for chronic pancreatitis from March 1987 to September 1997. Three tre atment categories were defined: Pancreatoduodenectomy, duodenum-preserving resection and drainage procedures, and left-sided pancreatectomy. Main outc ome measures were late mortality, pain scores preoperatively and at follow- up, body-weight change, percentage of insulin dependent; diabetes, patient' s and physician's satisfaction with surgery. Results: Forty-one patients underwent pancreatoduodenectomy, 59 drainage pr ocedures, and 26 left-sided pancreatectomy, respectively. Hospital mortalit y was 1 (2.4%), 4 (6.8%), and 1 (3.8%) (P=NS), totaling 4.8%. After an aver age follow-up of 5.2 years, late mortality was 10 (24.4%), 9 (15.3%), and 4 (15.4%) (P=NS) for a total of 23 (18.3%). Two patients (1.6%): died of uns uspected pancreatic cancer. Three patients (2.4%) had to be reoperated upon for pain relapse. The mean pain score was 8.8 preoperatively and 2.1 at la te follow-up and not different among groups. Body-weight gain averaged 3.0, 4.0, and 3.4kg, with no significant differences. Percentage of insulin dep endency in all patients rose from 14% prior to surgery to 30% at reevaluati on, and was very similar in all treatment; categories. Conclusions: The different kind and level of invasiveness of the surgical p rocedures did not significantly influence the late outcome. High rates of l ate mortality and deterioration of endocrine function are to a greater exte nt sequelae of comorbidity and the progression of the underlying pancreatic disease.