Abstracts
1999 Digestive Disease Week

# 2196 QUALITY OF LIFE AND LONG-TERM SURVIVAL AFTER SURGERY FOR CHRONIC PANCREATITIS
K A Campbell, T A Sohn, H A Pitt, P K Sauter, J Coleman, The Johns Hopkins Med Inst, Baltimore, MD; K D Lillemoe, Johns Hopkins Med Inst, Baltimore, MD; C J Yeo, The Johns Hopkins Med Inst, Baltimore, MD; J L Cameron, Johns Hopkins Med Inst, Baltimore, MD

We evaluated the long-term outcome and quality of life in patients undergoing surgical management for chronic pancreatitis. Methods: Between January 1980 and December 1996, 255 patients underwent surgery for chronic pancreatitis at The Johns Hopkins Hospital. The etiology of the disease, indications for surgery, patient characteristics and long-term survival were analyzed. A visual analog quality of life questionnaire containing 23 items based on a zero-to-ten scale (0=worst and 10=best) was sent to those patients alive at the time of the survey. Visual analog responses relating to before and after surgery were compared using a paired t-test. Results: During the 16 year review period, 263 operations were performed for chronic pancreatitis in 255 patients. The most common presenting symptoms were abdominal pain (88%), weight loss (36%), nausea/vomiting (30%), jaundice (14%) and diarrhea (12%). The etiology for pancreatitis was alcohol in 43%, idiopathic in 38%, pancreas divisum in 5%, ampullary abnormality in 4% and gallstones in 3%. Pancreaticoduodenectomy was the most common procedure in 96 patients (37%), followed by distal pancreatectomy in 67 (25%), Peustow in 52 (19%), sphincteroplasty in 37 (14%) and Duval in 5 (2%). Two hundred twenty-seven of the 255 patients were alive at last follow-up. For the entire cohort of patients, the 5- and 10-year actuarial survivals were 88% and 78%, respectively. One hundred six of the 227 living patients (47%) responded to the visual analog quality of life questionnaire. Patients reported improvement in all aspects of quality of life surveyed including enjoyment out of life, satisfaction with life, pain, number of hospitalizations, feelings of usefulness and overall health (p<0.005, paired t-test). In addition to improved quality of life after surgery, narcotic use was decreased (41% vs. 21%, p<0.01) and alcohol use was decreased (59% vs. 33%, p<0.001). However, patients often became diabetic (12% vs. 41%, p<0.0001) and required enzyme supplementation (34% vs 55%, p<0.01) after surgical intervention. Conclusions: These data suggest that surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and excellent long-term survival. This is the first study to evaluate quality of life after surgery for chronic pancreatitis in a reproducible analog fashion, with significant improvement reported in all quality of life measures. We conclude that surgery remains an excellent option for patients with chronic pancreatitis.

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