Outcome of pancreaticoduodenectomy for chronic pancreatitis

Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and pancreatic endocrine/exocrine function.

This retrospective analysis included 24 consecutive patients with chronic pancreatitis who received PD from April 1995 to March 2003. There were 21 men and 3 women. The age of the patients ranged from 21 years to 73 years, with a mean age of 44 years. Alcohol abuse, found in 14 patients (58.3%), was the most common predisposing factor. Local complications included stenosis of the pancreatic duct in 15 patients, biliary obstruction in 9, duodenal obstruction in 4 and left-sided portal hypertension in 1. The surgical indications were recurrent intractable pain (n=16), local complications (n=18), and suspicion of malignancy (n=6). Endocrine pancreatic function was assessed by the need to treat diabetes mellitus with dietary modification, oral hypoglycemic agents or insulin. Pancreatic exocrine function was assessed based on clinical symptoms. Pain severity was evaluated using a scoring system based on the use of analgesic medication. The mean duration of follow-up in 22 of 24 patients was 31 months, with a range of 4 to 90 months.

Preoperatively, pancreatic exocrine insufficiency was detected in 3 patients (3/24, 12.5%), exocrine insufficiency in 5 (5/24, 20.8%) and intractable abdominal pain requiring morphine injection in 16 (16/24, 66.7%). After PD, 4 patients had 5 complications, resulting in a morbidity rate of 17% and a mortality rate of 4%. Postoperative diabetes mellitus developed de novo in 3 patients (3/20, 15%) and postoperative pancreatic exocrine insufficiency was detected in 14 patients (14/22, 63.6%). Complete pain relief after surgery was noted in 12 patients (12/14, 85.7%).

In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function.