Long-term results after surgery for autoimmune sclerosing pancreatitis

Autoimmune sclerosing pancreatitis (ASP) is a recently recognized cause of chronic pancreatitis. The role of operative intervention in this disease is controversial. A single center experience with 161 consecutive pancreatic resections for chronic pancreatitis was retrospectively reviewed. Operative specimens were reanalyzed and assessed for histological features of ASP. Long-term outcome was assessed by patient survey. Eight patients were identified with histological changes consistent with ASP. The pancreatic anatomic configuration according to intraoperative findings and preoperative radiographic evaluation was categorized into (1) diffusely enlarged pancreas (n = 4), (2) localized mass (n = 2), or (3) refractory pancreatic duct disruption without pancreatic enlargement (n = 2). Five patients underwent pancreaticoduodenectomy and three patients underwent distal pancreatectomy. Perioperative morbidity, operative time, and intraoperative estimated blood loss were similar to the same operation for other etiologies of chronic pancreatitis. Biliary obstruction occurred in two patients. Seven patients were alive 5 +/- 0.4 years after operation. Good quality of life measured by the SF-36 questionnaire was present in 4 of 7 patients surveyed. Good pain control was achieved with return to work in 5 of 7 patients. Two patients with poor pain control received glucocorticosteroids therapy without improvement in symptoms. Patients with ASP and a mass suspicious for malignancy or refractory duct disruption require operative intervention. Early postoperative outcome, long-term pain control, and improvement in quality of life appear to be good.