Long-Term Results Following Pylorus-Preserving Pancreatoduodenectomy for Chronic Pancreatitis

Summary

A retrospective review of the medical records of all patients who had pylorus-preserving pancreatoduodenectomy (PPPD) for chronic pancreatitis at Lahey Clinic (Burlington, MA, U.S.A.) was performed to assess their long-term outcome. Mean follow-up period was 63 months (range, 1 month to 13.7 years). All patients who were alive were contacted by telephone. In cases in which the patient had died, information was gathered from family members and hospital records. Forty-five patients underwent PPPD for disabling chronic pancreatitis. The mean preoperative duration of pain was 50 months, with 70% of patients requiring daily narcotic. One resection required resection of the portal vein. One patient died within 30 days of the operation. Ninety-two percent had improvement of pain at 5 years. The mean pain score (0–10 scale) was 9.2 preoperatively and 1.5,.8,1.1,1.1, and .9 at 6 months, 1 year, 2 years, 5 years, and 10 years, respectively. Seventy-four percent of patients had a postoperative weight gain to an average of 92% of their preillness weight. Diabetes (of new onset) occurred in 14% of patients by 6 months and 46% by 5 years. Hypoglycemia was the cause of death in 1 patient who underwent total pancreatectomy. Four patients died from causes unrelated to PPPD, marginal ulcers occurred in 10% of patients, and 9 patients required late operations. We concluded that, in selected patients, resection of the head of the pancreas achieves long-term\ pain improvement in more than 90% of cases. The early development of diabetes mellitus is low but over longer follow-up reaches prevalence rates similar to those described in patients who have not undergone resection. Weight gain in this group was superior to that previously reported for our patients who underwent the “standard Whipple” operation for chronic pancreatitis.