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2006 Abstracts: Long-term Outcome After Distal Pancreatectomy For Chronic Pancreatitis
Back to 2006 Program and Abstracts
Long-term Outcome After Distal Pancreatectomy For Chronic Pancreatitis
Thomas Schnelldorfer1, Joshua M. Hubbard1, David N. Lewin2, David B. Adams1; 1Department of Surgery, Medical University of South Carolina, Charleston, SC; 2Department of Pathology, Medical University of South Carolina, Charleston, SC

Introduction: Distal pancreatectomy has an important role in the treatment of selected patients with severe chronic pancreatitis. This single-institution experience reviews the outcome after distal pancreatectomy for chronic pancreatitis. Methods: The records of 91 consecutive patients who underwent distal pancreatectomy for chronic pancreatitis between 1995 and 2003 were retrospectively reviewed and analyzed. Long-term outcome was assessed by patient survey with a mean follow-up of 5.1 years. Results: Indication for distal pancreatectomy was pancreatic duct disruption in 57 patients, intractable pain in 26 patients, and inflammatory mass within the tail in 8 patients. Peri-operative morbidity was 29% with intra-abdominal abscess (16%) and pancreatic fistula (5%) being the most common complications. Risk factors for increased morbidity were malnutrition, duration of symptoms, POSSUM physiologic score, and degree of parenchymal fibrosis. ICU stay was necessary in 13% of patients. Bowel function was regained 4±0.2 days after procedure and patients’ average length of stay was 8±1.4 days. There were two peri-operative deaths. Thirty-four patients were lost to follow-up and 7 patients died in the follow-up period. Thirty-eight percent of the remaining 50 patients were pain free and 22% had good pain control after the procedure. Seventy-two percent returned to work. Quality of life assessed by SF-36v2 questionnaire showed a mean physical component score on the 42±1.6 percentile and a mean mental component score on the 47±1.3 percentile using norm-based scoring. New onset of endocrine and exocrine insufficiency was present in 46% and 20% of patients respectively. Patients’ weight at follow-up was practically unchanged (mean weight loss 1±1.2kg). Conclusion: In patients with disease localized to the tail and body of pancreas causing pancreatic duct disruption, inflammatory masses, or intractable pain, distal pancreatectomy for chronic pancreatitis can be performed with a low mortality and acceptable morbidity. The procedure can provide good pain control, return to work, and satisfactory quality of life in the majority of patients.


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