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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.

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