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Long-term Outcome after Resection for Chronic Pancreatitis: Results of 203 Patients
Frank Makowiec, Hartwig Riediger, Eva Fischer, Ulrich Adam, Ulrich T. Hopt; Dept. of Surgery, University of Freiburg, Freiburg, Germany

Organ complications like biliary or duodenal stenosis as well as intractable pain are current indications for surgery in patients with chronic pancreatitis (CP). We here present our experience with pancreatic resection for CP and focus on the long-term outcome following surgery regarding pain and exocrine/endocrine pancreatic function. Methods: During the last 11 years 272 pancreatic resections were performed in our institution for CP. Perioperative mortality was 1%. Follow-up data using standardized questionnaires were available in 203 patients with a postoperative follow-up of > 12 months. The types of resection in these 203 patients were Whipple (9%), pylorus-preserving PD (PPPD; 42%), duodenum-preserving pancreatic head resection (DPPHR; 42%, 47 FREY, 38 BEGER), distal (6%) and one central resection. Eighty-six of the patients were part of a randomized study comparing PPPD and DPPHR, as reported earlier to the Society. All other patients were operated as indicated individually. The perioperative and follow-up (f/up) data were prospectively documented. Exocrine insufficiency was regarded as the presence of steatorrhea and/or the need for oral enzyme supplementation. Median postoperative f/up was 37 months. Results: Perioperative surgical morbidity was 25% and did not differ between the different types of resection. At last f/up 75% of the patients were pain-free (62%) or had pain less frequently than once per month (13%). Twenty-five percent had pain at least once per month (no difference between operative procedures). Patients with postoperative surgical complications more frequently reported pain during f/up (54%) compared to patients without surgical complications (32%; p<0.01). At last f/up 67% had exocrine insufficiency, half of them developed it during the postoperative course. Eighteen percent of the patients postoperatively developed de novo diabetes. Both, exocrine and endocrine insufficiency were independent of the type of surgery. After PPPD 10% of the patients had peptic jejunal ulcers whereas five percent presented with biliary complications after DPPHR. Late mortality is still not completely evaluated but at least 22 of the 272 patients (8%) died within six years after surgery, in most cases unrelated to CP. Conclusions: Pancreatic resection leads to adequate pain control in the majority of patients with CP. Long-term outcome does not depend on the type of surgical procedure but is influenced by postoperative surgical complications (regarding pain). Some patients develop procedure-related late complications. Late mortality is relatively high, probably due to the high co-morbidity (alcohol, smoking) in many of these patients.


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