A comparison of pancreaticoduodenectomy and duodenum‐preserving head resection for the treatment of chronic pancreatitis

Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
HPB (Impact Factor: 2.68). 10/2009; 11(8):677 - 683. DOI: 10.1111/j.1477-2574.2009.00118.x


Background:  For chronic pancreatitis, European prospective trials have concluded that duodenum-preserving head resections (DPHR) are associated with less morbidity and similar pain relief and quality of life (QoL) outcomes compared with pancreaticoduodenectomy (PD). However, DPHR procedures are seldom performed in North America.Methods:  Patients undergoing PD or DPHR for unremitting pain secondary to chronic pancreatitis were retrospectively identified. Quality of life was assessed cross-sectionally using the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30) and pancreatic cancer-specific supplemental module (QLQ-PAN26).Results:  Eighty-one patients underwent either a Whipple PD (n= 59) or a DPHR (Bern, Beger or Frey procedure, n= 22) for the treatment of pain caused by chronic pancreatitis over a 5-year period. The characteristics of patients undergoing DPHR and PD procedures were similar. Duration of procedure (360 min vs. 245 min), duration of hospital stay (12.0 days vs. 9.5 days) and estimated blood loss (535 ml vs. 214 ml) were all significantly less for DPHR patients (P < 0.05). Thirty-day morbidity and mortality, postoperative pain relief and QoL scores did not differ significantly between groups.Conclusions:  Duodenum-preserving head resection is equally as effective as PD in relieving pain and improving QoL in chronic pancreatitis patients, and involves a shorter hospital stay and less blood loss.

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    • "The patients in both groups were followed up carefully, especially for side effects from the agents, disease recurrence, and the patients’ QOL, as measured according to the European Organisation for Research and Treatment of Cancer’s (EORTC) quality of life questionnaire (quality of life questionnaire – core 30 or QLQ-C30) and the pancreatic cancer-specific supplemental module (quality of life questionnaire – pancreatic cancer module 26 or QLQ-PAN26) [10-13]. The assessment of patients’ QOL in both groups was carried out at each outpatient appointment. "
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    ABSTRACT: OBJECTIVE To research the optimal surgical strategy for chronic pancreatitis. DATA SOURCES PubMed, EMBASE, Science Citation Index, SpringerLink, and secondary sources from inception through December 31, 2011, with no restrictions on languages or regions. STUDY SELECTION All controlled experimental (randomized and nonrandomized) studies in which duodenum-preserving pancreatic head resection was compared with pancreaticoduodenectomy in chronic pancreatitis. DATA EXTRACTION Data were extracted independently and in duplicate by 2 reviewers; discrepancies were resolved by discussion. DATA SYNTHESIS A total of 1007 patients from 15 studies were included in the meta-analysis. The relative risks for postoperative pain relief and postoperative morbidity in the Beger procedure were 1.29 (95% CI, 1.03-1.61; P = .03) and 0.55 (0.21-1.39; P = .20), respectively, compared with pancreaticoduodenectomy. These results are just the opposite in the Frey procedure, in which a significantly better outcome was shown in postoperative morbidity compared with resection (relative risk, 0.60; 95% CI, 0.46-0.78; P < .01) but not in postoperative pain relief (1.03; 0.90-1.17; P = .67). In terms of quality of life, pancreatic exocrine function, and delayed gastric emptying, the results also favored duodenum-preserving strategies. CONCLUSIONS For the duodenum-preserving strategy of the Beger procedure, complete pain relief is achieved in most patients, but there is no evidence that it has a better result in postoperative morbidity. For the Frey procedure, a significantly lower postoperative morbidity is demonstrated, but complete pain relief is not provided in most cases. Thus, compared with conventional pancreaticoduodenectomy, both new strategies should be recommended on the basis of the patients' appropriate individual preferences.
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