Follow-Up after Resection for Chronic Pancreatitis: Results of 162 Patients
Abstracts
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Background: There is increasing evidence that surgical treatment of chronic pancreatitis (CP) improves quality of life. However, hardly any risk factors for outcome parameters after surgery have been defined. Methods: From 1994 until 2001 196 pancreatic resections (Whipple 11%, pylorus preserving pancreatoduodenectomy 46%, duodenum preserving head resection 35%, distal resection 8%) were performed in patients with CP. Hospital mortality was 1%. Of the surviving 194 patients 162 (83.5%) had a follow-up examination including a standardized questionnaire during 2000/2001. Five patients (2.6%) died (unrelated to CP) without follow-up, 27 patients (13.9%) were lost to follow-up. Median preoperative duration of CP was 36 months. Follow-up averaged 31 +/- 21 months. Exocrine insufficiency (ExIns) was defined as oral enzyme substitution with or without steatorrhea. Pain control was classified as good (no pain or pain less than once/month; 80.2%) or poor (pain at least once per month; 19.8%). The influences of demographic, perioperative and morphologic parameters on the outcome (pain, ExIns, diabetes) were examined by uni- and multivariate analysis. Results: Total morbidity was 38%, abdominal complications (AbdCompl) occurred in 26%. At follow-up 66% were pain free, 14% had pain less than monthly, 9% at least monthly, 8% at least weekly and 3% daily. In multivariate analysis AbdCompl and ExIns were correlated with pain (p<0.05/p<0.001; relative risk (RR) 2.5/4.5) or poor pain control (p<0.001/p<0.01; RR 4.3/7.0). ExIns was present at follow-up in 65%, half of them with postoperative new onset ExIns. A duration of CP of more than 3 years was the only risk factor for ExIns multivariately (p=0.02, RR 2.3). No risk factor for new onset ExIns was found. Diabetes was present in 44% at follow-up (29% of them with new onset diabetes). ExIns at time of surgery was the only risk factor for diabetes in multivariate analysis (p<0.05, RR 4.7). Distal resection was a risk factors for new onset diabetes (p<0.02; RR 1.5 vs. head resection). There was a clear correlation between ExIns and endocrine insufficiency at follow-up (p<0.02). Conclusions: Pain control is good in the majority of patients after resection for CP. Postoperative surgical complications and/or advanced or recurrent disease are risk factors for persistent pain. In patients undergoing pancreatic head resection exocrine and endocrine insufficiency are mainly influenced by longstanding and/or advanced CP but not by the type of surgery performed. |
