Operative management of chronic pancreatitis: longterm results in 372 patients.

Abstract

BACKGROUND:

Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment, or for the presence of complications of the disease. This study evaluates a single-center experience with operative management of chronic pancreatitis.

STUDY DESIGN:

The records of 372 consecutive patients who underwent lateral pancreaticojejunostomy (n = 184), pancreaticoduodenectomy (n = 97), or distal pancreatectomy (n = 91) for chronic pancreatitis between 1995 and 2003 were retrospectively reviewed and analyzed. Longterm outcomes were assessed by patient survey, with a median followup of 5.5 +/- 0.2 years.

RESULTS:

Primary indication for operative treatment included intractable pain (n = 215), pancreatic duct disruption (n = 109), inflammatory mass (n = 42), or biliary obstruction (n = 6). Perioperative morbidity was 22%, 51%, and 29% after lateral pancreaticojejunostomy, pancreaticoduodenectomy, and distal pancreatectomy, respectively, with a perioperative mortality rate of 1%. Two hundred twenty-eight patients were available for longterm followup. Fifty-eight patients (25%) died in the followup period. Twenty-four percent of the remaining 170 patients were pain free, and 25% had good pain control after the procedure. On multivariate analysis, risk factors for poor pain control were pancreaticoduodenectomy (p < 0.01), preoperative narcotic dependence (p < 0.02), earlier abdominal operations (p < 0.02), and an absent history of gallstone pancreatitis (p < 0.05). Sixty-two percent returned to work. Quality of life assessed by SF-36 version 2 questionnaire showed norm-based scores between the 35th and 46th percentile and slightly below, but not substantially different from, a general population. New onset of endocrine and exocrine insufficiency was present in 35% and 29% of patients, respectively.

CONCLUSIONS:

Operative management of chronic pancreatitis can be performed with low mortality and acceptable morbidity. Surgical treatment can provide good pain control, return patients to work, and achieve a satisfactory quality of life in the majority of patients. Longterm mortality is high in a subset of patients.

• Authors: Thomas Schnelldorfer, David N Lewin, David B Adams
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 204 Issue 5 Pg. 1039-45; discussion 1045-7 (May 2007) ISSN: 1072-7515 [Print] United States
• PMID: 17481536 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Chi-Square Distribution
• Female
• Humans
• Male
• Middle Aged
• Pain, Intractable (etiology, surgery)
• Pancreatectomy (mortality)
• Pancreaticoduodenectomy (mortality)
• Pancreaticojejunostomy (mortality)
• Pancreatitis, Chronic (complications, mortality, surgery)
• Quality of Life
• Regression Analysis
• Treatment Outcome