Pancreatoduodenectomy for Chronic Pancreatitis-Results of a Pain Relief and Quality of Life Survey 15 Years Following Operation.
BACKGROUND
Over the last 30 years, numerous developments in the management of chronic pancreatitis have occurred, leading to multiple surgical and non-surgical options.


METHODS
All patients who underwent pancreatoduodenectomy for chronic pancreatitis from January 1976 to July 2013 were reviewed. Surviving patients were contacted for a follow-up questionnaire and Short Form (SF)-12 Quality of Life Survey administration.


RESULTS
A total of 166 patients were identified (cohort 1:1976-1997(N = 105) and cohort 2:1998-2013(N = 61)). Prior to pancreatoduodenectomy, a higher proportion of patients in cohort 2 had undergone endoscopic stenting, 67 vs 10 % (p < 0.001) and/or celiac plexus block 15 and 5 % (p = 0.026). Median follow-up for all survey respondents was 15 years. On the SF-12, mean physical component score was 43.8 ± 11.8 and mental component score was 54.3 ± 7.9. Patients were significantly lower on the physical component score (p < 0.001) and significantly better on the mental component score (p = 0.001) than the general US population. Mean pain score out of 10 was significantly lower after surgery 1.6 ± 2.6 than before surgery 7.9 ± 3.5 (p < 0.001). Diabetes developed in 28 % of patients who were not diabetic prior to surgery.


CONCLUSIONS
Although practice has changed so that patients have a longer time from presentation until surgery as less-invasive techniques are attempted, pancreatoduodenectomy appears to provide effective long-term pain relief and acceptable quality of life in appropriately selected patients with chronic pancreatitis and intractable pain.
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
Kristopher P
KP
Croome
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
May
M
Tee
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
David M
DM
Nagorney
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
Mark J
MJ
Truty
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
K Marie
KM
Reid-Lombardo
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
Florencia G
FG
Que
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
Michael L
ML
Kendrick
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA. Farnell.michael@mayo.edu.
Michael B
MB
Farnell
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010148:Intractable Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000601:surgery*; D018579:Patient Selection; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
Chronic pancreatitis; Long-term follow-up; Pancreatoduodenectomy; Whipple