Long-term results of pylorus-preserving pancreatoduodenectomy for chronic pancreatitis
R. F. Martin, R. L. Rossi and K. A. Leslie
Lahey Clinic Medical Center, Burlington, Massachusetts, USA.
OBJECTIVE: To assess the long-term outcome of patients following
pylorus-preserving pancreatoduodenectomy (PPPD) for chronic pancreatitis.
DESIGN: Retrospective study with mean follow-up of 63 months (range, 1
month to 13.7 years). SETTING: Tertiary referral hospital. PATIENTS:
Records of all patients who underwent PPPD for chronic pancreatitis at
Lahey Clinic were reviewed. All patients who were alive were contacted by
telephone. In cases where patients had died, information was gathered from
family members and hospital records. RESULTS: Forty-five patients underwent
PPPD for disabling chronic pancreatitis. The mean preoperative duration of
pain was 50 months, with 32 patients (70%) requiring daily narcotics. In
one patient resection of the portal vein was required. One patient died
within 30 days of the operation. Forty-one patients (92%) had improvement
of pain at 5 years. The mean pain score (on a scale of 0 to 10) was 9.2
preoperatively and 1.5, 0.8, 1.1, and 1.1 at 6 months, 1 year, 2 years, and
5 years, respectively. Thirty-three patients (74%) had a postoperative
weight gain to an average of 92% of their pre-illness weight. New-onset
diabetes occurred in six patients (14%) by 6 months and in 21 patients
(46%) by 5 years. Hypoglycemia was the cause of death in one patient who
underwent total pancreatectomy. Four patients died of causes unrelated to
PPPD. Marginal ulcers occurred in five patients (10%). Nine patients
required late operations. CONCLUSIONS: In selected patients, resection of
the head of the pancreas achieves long-term pain improvement in over 90% of
cases. The early development of diabetes mellitus is infrequent, but over
longer follow-up periods it 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 "standard Whipple" operation for chronic pancreatitis.
