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Long-Term Outcome After 92 Duodenum-Preserving Pancreatic Head Resections for Chronic Pancreatitis: Comparison of Frey- and Beger-Procedures
Tobias Keck*1, Ulrich Adam2,1, Hartwig Riediger1,2, Ulrich T. Hopt1, Frank Makowiec1
1Dept. of Surgery, University of Freiburg, Freiburg, Germany; 2Dept. of Surgery, Vivantes-Humboldt-Klinikum, Berlin, Germany
Duodenum-preserving pancreatic head resections (DPPHR) in the techniques described by FREY or BEGER may be an alternative to pancreaticoduodenectomy (PD) or drainage procedures for chronic pancreatitis (CP) predominantly of the pancreatic head. Data comparing the outcomes after both operations are rare. We, therefore, analyzed our long-term results after DPPHR in 92 patients.
Methods: Since 1995 113 patients underwent DPPHR for CP predominantly of the pancreatic head. The decision to perform either a FREY- or a BEGER procedure was always made individually depending upon the complications and morphological classification of CP. Up to now prospective outcome results including standardized questionnaires could be obtained in 92 patients with a median postoperative follow-up of 43 months. Of those 92 patients (82% male, median age 44 years) 77% had alcoholic CP. The leading indications for surgery were pain (87%), recurrent attacks of CP (90%), jaundice (22%) or symptomatic duodenal stenosis (10%).
Results: Any / surgery related postoperative complications occurred in 31%/20% after FREY-procedures and in 41%/30% after BEGER-procedures (n. s.). In median 43 months after surgery 62% (FREY) and 50% (BEGER) of the patients were completely free of pain, respectively. In the collection of patients still or again suffering from pain (FREY vs. BEGER) 6% / 19% had pain at least once per week or daily and the remaining 32% / 31% experienced pain attacks at least once per year (difference for pain frequency p=0.55). Diabetes was documented in 57% (BEGER) and 60% (FREY; n.s.). During postoperative follow-up a de-novo diabetes occured in 17% after BEGER- and in 34% after FREY-procedures (p=0.06). The frequencies of an exocrine insufficiency (74% vs. 76%, p=0.8) and a postoperative de-novo exocrine insufficiency (33% vs. 34%; p=0.9) were identical. The median gain in body weight until the last follow-up was not significantly different (three kg after BEGER vs. two kg after FREY). Two patients in each group had relevant biliary complications (stenosis or symptomatic duct stones) during follow-up requiring re-intervention. Actuarial five-year survival after DPPHR was 96% and clearly higher than survival in the 110 patients who underwent PD for CP at our institution (five-year survival 82%).
Conclusions: Comparison of the outcomes after either a FREY- or a BEGER-procedure for CP reveals a tendency for better pain control after the FREY-operation. The functional outcomes (organ function, biliary) were almost identical. Surprisingly, late mortality after DPPHR was clearly lower than reported in other series and in the patients undergoing PD for CP at our institution.
