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Five-Year Outcome of a Randomized Trial Comparing Pylorus- and Duodenum-Preserving Pancreatic Head Resection for Chronic Pancreatitis
Ulrich Adam*, Frank Makowiec, Eva Fischer, Tobias Keck, Hartwig Riediger, Ulrich T. Hopt
Dept. of Surgery, University of Freiburg, Freiburg, Germany
The ‘ideal’ technique of pancreatic head resection (PHR) for chronic pancreatitis (CP) is still discussed controversially. Although few trials have shown advantages for duodenum-preserving (DPPHR) techniques many centres continue to perform pancreaticoduodenectomies either as Whipple or pylorus-preserving (PPPD) procedures. After presentation of our initial results to the Society in 2004 we have performed further follow-up evaluations and can now report the five-year outcomes after randomization of patients to either DPPHR or PPPD. Our initial evaluations (perioperative course and three-year outcome) showed comparable results between the groups including quality of life.
Methods: We re-evaluated the outcome in 85 patients who were randomly assigned to DPPHR (n=42) or PPPD (n=43) between 1997 and 2001. After randomization for DPPHR the surgeon could decide, depending upon the morphology of CP, to perform either a FREY- (n=22) or a BEGER-procedure (n=20). Follow-up evaluations were performed by standardized questionnaires, supplemented by phone contacts with the home physicians. Median postoperative follow-up was now 61 months.
Results: Preoperatively, demographic and CP-related data showed no difference between the groups. After a median of 61 months following surgery 63% (PPPD) and 57% (DPPHR) of the patients were completely free of pain, respectively (n.s.). Among the patients still suffering from pain (PPPD vs. DPPHR) 2% / 4% had pain every day, 7% / 7% had pain at least once per week, 7% / 14% at least once per month and 20% / 17% complained of pain less frequently (no difference between the groups). The pain scores as well showed no differences. Diabetes was documented in 44% (PPPD) and 45% (DPPHR), respectively, postoperative de novo-diabetes in 19% (PPPD) and 26% (DPPHR; n.s.). The frequencies of exocrine insufficiency (61% vs. 76%, p=0.12) and postoperative de-novo exocrine insufficiency (21% vs. 26%; p=0.57) were also comparable. Median gain in body weight was three kg after PPPD and two kg after DPPHR; n.s.). Further subgroup comparisons in the patients undergoing DPPHR (FREY vs. BEGER) did not reveal any differences in outcome.Up to now 15 of the 85 patients died a median of 3.5 years after surgery, in most cases as a consequence of alcohol and/or tobacco use. Actuarial survival was 82% after five and 70% after ten years, without differences between the two randomized groups.
Conclusions: The late results of our randomized study demonstrate a comparable outcome after PPPD or DPPHR even five years after surgery. The type of PHR for CP might, therefore, be adapted to the morphology of CP and its local complications.
