Postobstructive chronic pancreatitis: results with distal resection.
OBJECTIVE
For most patients with chronic obstructive pancreatitis, distal pancreatectomy confers pain relief.


METHODS
Retrospective case series. Follow-up was complete in 80% of study subjects (mean follow-up, 6.7 years).


METHODS
Tertiary care center.


METHODS
Among 484 patients with chronic pancreatitis undergoing operation from 1976 to 1997, 40 with postobstructive chronic pancreatitis were identified. Criteria for selection included an isolated, dominant major pancreatic duct stricture or cutoff, changes of chronic pancreatitis in the distal pancreas, and ostensibly normal parenchyma without calcification in the proximal gland. The patients were reviewed with regard to operative procedure, postoperative course, and outcome.


METHODS
Outcome measures included degree of pain relief, morbidity and mortality of operation, survival, rates of endocrine and exocrine insufficiency, and ability to return to work and/or normal activities.


RESULTS
All but 1 of the 40 patients had abdominal pain, and 20 (50%) had recurrent episodes of acute pancreatitis. Suspicion of malignancy was a concern in 16 patients (40%). Thirty-eight patients underwent distal pancreatectomy; 1 had a central resection and another a Roux-en-Y cystojejunostomy. There was no operative mortality, but significant morbidity occurred in 15%. Among 31 patients with preoperative pain in whom long-term follow-up was available, complete or significant pain relief was achieved in 25 (81%); 74% returned to normal social function, but about half had some element of pancreatic insufficiency.


CONCLUSIONS
Distal pancreatectomy is a safe procedure and achieves pain relief and good quality of life in a large percentage of patients (80%) with presumed postobstructive chronic pancreatitis. However, some of these patients with chronic pancreatitis involving the entire gland have disease masquerading as postobstructive chronic pancreatitis secondary to an ostensibly isolated dominant pancreatic ductal stricture.
Sakorafas
G H
GH
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Sarr
M G
MG
Rowland
C M
CM
Farnell
M B
MB
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010147:Pain Measurement; D010180:Pancreatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality / Q000523:psychology; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome