Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 2/2008

01-02-2008

Long-term Follow-up After Organ-Preserving Pancreatic Head Resection in Patients with Chronic Pancreatitis

Authors: Gyula Farkas, László Leindler, Mária Daróczi, Gyula Farkas Jr.

Published in: Journal of Gastrointestinal Surgery | Issue 2/2008

Login to get access

Abstract

In chronic pancreatitis (CP), enlargement of the pancreatic head develops as a result of inflammatory alterations. This report relates to the results attained with an organ-preserving pancreatic head resection (OPPHR) in 135 patients in a 7-year period. The surgical procedure consists of a wide excision of the inflammatory tumor in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, takes place through a jejunal Roux-en-Y loop. Only one reoperation was required in consequence to anastomosis bleeding, but no mortality occurred in the postoperative period. The duration of hospitalization ranged between 7 and 12 days. The mean follow-up period was 4.1 years (range, 0.5–7.0). The late mortality rate was 3.7%. The quality of life, measured during the follow-up by using EORTC Quality-of-Life Questionnaire, improved in 89% of the patients. One hundred sixteen patients became complaint-free, while 14 patients had moderate symptoms; the weight increased by a median of 11.3 kg (range, 4–28). The 7-year experience clearly reveals that this OPPHR technique is a safe and effective procedure for definitive control of the complications of CP.
Literature
1.
go back to reference Büchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 1995;169:65–69.PubMedCrossRef Büchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 1995;169:65–69.PubMedCrossRef
2.
go back to reference Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 1999;79(4):913–944.PubMedCrossRef Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 1999;79(4):913–944.PubMedCrossRef
3.
go back to reference Beger HG, Schlosser W, Poch B, Gansague F. Inflammatory mass in the head of the pancreas. In Beger HG, Warshaw AL, Büchler MW, Carr-Locke DL, Neoptolemos JP, Russell C, Sarr MG, eds. The Pancreas, vol. 1, Oxford, London: Blackwell Science, 1998, pp 757–760. Beger HG, Schlosser W, Poch B, Gansague F. Inflammatory mass in the head of the pancreas. In Beger HG, Warshaw AL, Büchler MW, Carr-Locke DL, Neoptolemos JP, Russell C, Sarr MG, eds. The Pancreas, vol. 1, Oxford, London: Blackwell Science, 1998, pp 757–760.
4.
go back to reference Traverso LW, Longmire WP. Preservation of the pylorus during pancreatico-duodenectomy. Surg Gynecolog Obstet 1978;146:959–962. Traverso LW, Longmire WP. Preservation of the pylorus during pancreatico-duodenectomy. Surg Gynecolog Obstet 1978;146:959–962.
5.
go back to reference Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 1985;97:467–473.PubMed Beger HG, Krautzberger W, Bittner R, Büchler M, Limmer J. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 1985;97:467–473.PubMed
6.
go back to reference Gloor B, Friess H, Uhl W, Büchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 2001;18:21–25.PubMedCrossRef Gloor B, Friess H, Uhl W, Büchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg 2001;18:21–25.PubMedCrossRef
7.
go back to reference Köninger J, Friess H, Müller M, Wirtz M, Martignioni M, Büchler MW. Duodenum-preserving pancreas head resection—an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 2004;75:781–788.PubMedCrossRef Köninger J, Friess H, Müller M, Wirtz M, Martignioni M, Büchler MW. Duodenum-preserving pancreas head resection—an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 2004;75:781–788.PubMedCrossRef
8.
9.
go back to reference Farkas G, Leindler L, Daróczi M, Farkas G Jr. Organ-preserving pancreatic head resection in chronic pancreatitis. Br J Surg 2003;90:29–32.PubMedCrossRef Farkas G, Leindler L, Daróczi M, Farkas G Jr. Organ-preserving pancreatic head resection in chronic pancreatitis. Br J Surg 2003;90:29–32.PubMedCrossRef
10.
go back to reference Farkas G, Leindler L, Farkas G Jr, Daróczi M. Organ-preserving resection of the pancreatic head in patients with chronic pancreatitis. Magy Seb 2004;57:279–282.PubMed Farkas G, Leindler L, Farkas G Jr, Daróczi M. Organ-preserving resection of the pancreatic head in patients with chronic pancreatitis. Magy Seb 2004;57:279–282.PubMed
11.
go back to reference Farkas G, Leindler L, Daróczi M, Farkas G Jr. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreatoduodenectomy. Langenbecks Arch Surg 2006;391:338–342.PubMedCrossRef Farkas G, Leindler L, Daróczi M, Farkas G Jr. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreatoduodenectomy. Langenbecks Arch Surg 2006;391:338–342.PubMedCrossRef
12.
go back to reference Farkas G, Leindler L, Daróczi M, Farkas G Jr. Reply to the letter by Markus W. Büchler et al. on our publication. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreatoduodenectomy. Langenbecks Arch Surg 2007;392:117.CrossRef Farkas G, Leindler L, Daróczi M, Farkas G Jr. Reply to the letter by Markus W. Büchler et al. on our publication. Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreatoduodenectomy. Langenbecks Arch Surg 2007;392:117.CrossRef
13.
go back to reference Löser C, Möllgaard A, Fölsch UR. Faecal elastase1; a novel, highly sensitive, and specific tubeless pancreatic function test. Gut 1996;39:580–586.PubMedCrossRef Löser C, Möllgaard A, Fölsch UR. Faecal elastase1; a novel, highly sensitive, and specific tubeless pancreatic function test. Gut 1996;39:580–586.PubMedCrossRef
14.
go back to reference Aaronson NK, Ahmedzai S, Bergmann B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instruments for use in international clinical trials in oncology. J Natl Cancer Ins 1993;85:365–376.CrossRef Aaronson NK, Ahmedzai S, Bergmann B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instruments for use in international clinical trials in oncology. J Natl Cancer Ins 1993;85:365–376.CrossRef
15.
go back to reference Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch Ce. Quality of life in chronic pancreatitis: results after duodenum-preserving resection of the head of the pancreas. Pancreas 1995;11:77–85.PubMedCrossRef Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch Ce. Quality of life in chronic pancreatitis: results after duodenum-preserving resection of the head of the pancreas. Pancreas 1995;11:77–85.PubMedCrossRef
16.
go back to reference Sohn TA, Campbell KA, Pitt HA, Sauter PK, Coleman JA, Lillemoe KD, Yeo CJ, Cameron KD. Quality of life and long-term survival after surgery for chronic pancreatitis. J Gastrointest Surg 2000;4:355–365.PubMedCrossRef Sohn TA, Campbell KA, Pitt HA, Sauter PK, Coleman JA, Lillemoe KD, Yeo CJ, Cameron KD. Quality of life and long-term survival after surgery for chronic pancreatitis. J Gastrointest Surg 2000;4:355–365.PubMedCrossRef
17.
go back to reference Belina F, Fronek J, Ryska M. Duodenopancreatectomy versus duodenum-preserving pancreatic head excision for chronic pancreatitis. Pancreatology 2005;5:547:552.PubMedCrossRef Belina F, Fronek J, Ryska M. Duodenopancreatectomy versus duodenum-preserving pancreatic head excision for chronic pancreatitis. Pancreatology 2005;5:547:552.PubMedCrossRef
18.
go back to reference Howard JM. Surgical treatment of chronic pancreatitis. In Howard JM, Jordan GL Jr, Reber HA, eds. Surgical Diseases of the Pancreas. Philadelphia: Lea and Febiger, 1987, pp 496–521. Howard JM. Surgical treatment of chronic pancreatitis. In Howard JM, Jordan GL Jr, Reber HA, eds. Surgical Diseases of the Pancreas. Philadelphia: Lea and Febiger, 1987, pp 496–521.
19.
go back to reference Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman JA, Hruban RH, Cameron JL. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg 2000;231:890–898.PubMedCrossRef Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman JA, Hruban RH, Cameron JL. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg 2000;231:890–898.PubMedCrossRef
20.
go back to reference Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis. Long-term result in 105 patients. Arch Surg 2000;135:517–524.PubMedCrossRef Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis. Long-term result in 105 patients. Arch Surg 2000;135:517–524.PubMedCrossRef
21.
go back to reference Yamaguchi K, Yokohata K, Nakano K, Ohtani K, Ogawa Y, Chijiiwa K, Tanaka M. Which is a less invasive pancreatic head resection: PD, PPPD, or DPPHR? Dig Dis Sci 2001;46:282–288.PubMedCrossRef Yamaguchi K, Yokohata K, Nakano K, Ohtani K, Ogawa Y, Chijiiwa K, Tanaka M. Which is a less invasive pancreatic head resection: PD, PPPD, or DPPHR? Dig Dis Sci 2001;46:282–288.PubMedCrossRef
22.
go back to reference Witzigmann H, Max D, Uhlmann D, Geissler F, Schwarz R, Ludwig S, Lohmann T, Caca K, Keim V, Tannapfel A, Hauss J. Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery 2003;134:53–62.PubMedCrossRef Witzigmann H, Max D, Uhlmann D, Geissler F, Schwarz R, Ludwig S, Lohmann T, Caca K, Keim V, Tannapfel A, Hauss J. Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery 2003;134:53–62.PubMedCrossRef
23.
go back to reference Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease. A single-center 26-year experience. Ann Surg 1999;230:512–523.PubMedCrossRef Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease. A single-center 26-year experience. Ann Surg 1999;230:512–523.PubMedCrossRef
24.
go back to reference Falkoni M, Bassi C, Casseti L, Mantovani G, Sartori N, Frulloni L, Pederzoli P. Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006;10:504–510.CrossRef Falkoni M, Bassi C, Casseti L, Mantovani G, Sartori N, Frulloni L, Pederzoli P. Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006;10:504–510.CrossRef
25.
go back to reference Aspelund G, Topazian MD, Lee JH, Andersen DK. Improved outcomes for benign disease with limited pancreatic head resection. J Gastrointest Surg 2005;9:400–409.PubMedCrossRef Aspelund G, Topazian MD, Lee JH, Andersen DK. Improved outcomes for benign disease with limited pancreatic head resection. J Gastrointest Surg 2005;9:400–409.PubMedCrossRef
26.
go back to reference Büchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 1995;169:65–69.PubMedCrossRef Büchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 1995;169:65–69.PubMedCrossRef
27.
go back to reference Klempa I, Spatny M, Menzel J, Baca I, Nustede R, Stockmann F, Arnold W. Pancreatic function and quality of life after resection of the head of pancreas in chronic pancreatitis: a prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple’s operation. Chirurg 1995;66:350–359.PubMed Klempa I, Spatny M, Menzel J, Baca I, Nustede R, Stockmann F, Arnold W. Pancreatic function and quality of life after resection of the head of pancreas in chronic pancreatitis: a prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple’s operation. Chirurg 1995;66:350–359.PubMed
28.
go back to reference Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective randomized trial. Ann Surg 1995;221:350–358.PubMedCrossRef Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective randomized trial. Ann Surg 1995;221:350–358.PubMedCrossRef
29.
go back to reference Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Soehendra N, Broelsch CE. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas. Chirurg 1997;68:369–377.PubMedCrossRef Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Soehendra N, Broelsch CE. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas. Chirurg 1997;68:369–377.PubMedCrossRef
30.
go back to reference Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure). World J Surg 2003;27:1217–1230.PubMedCrossRef Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure). World J Surg 2003;27:1217–1230.PubMedCrossRef
31.
go back to reference Strate T, Taherpour Z, Bloechle C, Mann O, Bruhn JP, Schneider C, Kuechler T, Yekebas E, Izbicki JR. Long-term follow-up of a randomized trial comparing the Bager and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005;241:591–598.PubMedCrossRef Strate T, Taherpour Z, Bloechle C, Mann O, Bruhn JP, Schneider C, Kuechler T, Yekebas E, Izbicki JR. Long-term follow-up of a randomized trial comparing the Bager and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005;241:591–598.PubMedCrossRef
32.
go back to reference Köninger J, Friess H, Müller M, Wirtz M, Martignioni M, Büchler MW. Duodenum-preserving pancreas head resection: an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 2004;75:781–788.PubMedCrossRef Köninger J, Friess H, Müller M, Wirtz M, Martignioni M, Büchler MW. Duodenum-preserving pancreas head resection: an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg 2004;75:781–788.PubMedCrossRef
33.
go back to reference Shrikhande SV, Kleef J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006;10:227–233.PubMedCrossRef Shrikhande SV, Kleef J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006;10:227–233.PubMedCrossRef
Metadata
Title
Long-term Follow-up After Organ-Preserving Pancreatic Head Resection in Patients with Chronic Pancreatitis
Authors
Gyula Farkas
László Leindler
Mária Daróczi
Gyula Farkas Jr.
Publication date
01-02-2008
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 2/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-007-0324-7

Other articles of this Issue 2/2008

Journal of Gastrointestinal Surgery 2/2008 Go to the issue