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Central pancreatic head resection appears to safely resolve complications of chronic pancreatitis

Friday, September 19 2008 | Comments

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What's This? Results of a prospective study of central pancreatic head resection (CPHR) indicate that it is a safe and effective procedure for resolving the complications of chronic pancreatitis associated with an enlarged pancreatic head, and that it provides long-term improvement in functioning and quality of life (QOL).

Between January 2002 and December 2006, a Phase II evaluation of 100 consecutive patients (mean age, 46.0 years; n=70 male) undergoing CPHR for chronic pancreatitis was conducted. Of the 100 patients evaluated, 73 with follow-up >12 months (median, 41 months) were ultimately included in the study.

The diagnosis of chronic pancreatitis was confirmed on the basis of clinical history and a computed tomography scan or magnetic resonance imaging. Endoscopic retrograde cholangiopancreatography was also sometimes used. The main indications for surgery were the presence of an inflammatory pancreatic head mass, intractable pain, compression and obstruction of the common bile duct or duodenum, and/or entrapment of the retroperitoneal portal vein or superior mesenteric vein or both.

The study assessed perioperative surgical success and long-term parameters such as intensity and frequency of pain and the requirement for analgesic medication; patient functioning and QOL, including ability to work, physical fitness, appetite, and ability to sleep; and pancreatic functioning as measured by the need for pancreatic enzyme substitution, endocrine status, hospital readmissions, and attacks of acute pancreatitis.

The hospital mortality rate was 1% and surgical morbidity was 16%. There was a 6% incidence of relaparotomy. Mean surgery time was 295 minutes, mean intraoperative blood loss was 763 mL, and mean length of stay was 11.4 days.

After long-term follow-up, endocrine function was unchanged in 59 patients (80.8%), improved in 1 patient (1.4%), and deteriorated in 13 patients (17.8%). Insulin-dependent diabetes developed in 9 patients (12.3%) while 4 (5.5%) were treated with oral antidiabetics. Pancreatic enzyme substitution was required in 57 patients (78.1%).

During follow-up, 28 patients (38.4%) reported moderate to severe pain compared with 42 patients (57.5%) before surgery. Thirty-five patients (47.9%) still required analgesics to control pain compared with 54 (73.9%) before treatment.

Of the 73 patients followed long term, 89.0% indicated they were satisfied with the surgery, 53.4% said they were physically fit, and 76.7% reported subjective well-being. Appetite was reported to be good in 54 patients (74.0%), and sleep was assessed as good in 36 patients (49.3%).

This study shows that CPHR addresses all complications of pancreatic head enlargement in patients with chronic pancreatitis, according to the authors. "Our results underscore that CPHR can be performed safely, with low mortality and morbidity rates comparable with those of the Beger and the Frey procedures," they noted. (Muller MW, et al. Am J Surg 2008;196:364-372.)

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