Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 12/2015

01-12-2015 | Original Article

Pancreatoduodenectomy for Chronic Pancreatitis—Results of a Pain Relief and Quality of Life Survey 15 Years Following Operation

Published in: Journal of Gastrointestinal Surgery | Issue 12/2015

Login to get access

Abstract

Background

Over the last 30 years, numerous developments in the management of chronic pancreatitis have occurred, leading to multiple surgical and non-surgical options.

Patients and 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.

Conclusion

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.
Literature
1.
go back to reference Yin Z, Sun J, Yin D, Wang J. Surgical treatment strategies in chronic pancreatitis: a meta-analysis. Arch Surg 2012; 147(10):961-8.CrossRefPubMed Yin Z, Sun J, Yin D, Wang J. Surgical treatment strategies in chronic pancreatitis: a meta-analysis. Arch Surg 2012; 147(10):961-8.CrossRefPubMed
2.
go back to reference Duffy JP, Reber HA. Surgical treatment of chronic pancreatitis. J Hepatobiliary Pancreat Surg 2002; 9:659-668.CrossRefPubMed Duffy JP, Reber HA. Surgical treatment of chronic pancreatitis. J Hepatobiliary Pancreat Surg 2002; 9:659-668.CrossRefPubMed
3.
go back to reference Ho HS, Frey CF. Current approach to the surgical management of chronic pancreatitis. Gastroenterologist 1997; 5:128-136.PubMed Ho HS, Frey CF. Current approach to the surgical management of chronic pancreatitis. Gastroenterologist 1997; 5:128-136.PubMed
4.
go back to reference Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Laméris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356:676–684.CrossRefPubMed Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Laméris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356:676–684.CrossRefPubMed
5.
go back to reference Beger HG, Krautzberger W, Bittner R, Buchler 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, Buchler 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 Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2:701–707.CrossRefPubMed Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2:701–707.CrossRefPubMed
7.
go back to reference Weber A, Schneider J, Neu B, Meining A, Born P, von Delius S, Bajbouj M, Schmid RM, Algül H, Prinz C. Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol. 2013; 19(5):715-20.PubMedCentralCrossRefPubMed Weber A, Schneider J, Neu B, Meining A, Born P, von Delius S, Bajbouj M, Schmid RM, Algül H, Prinz C. Endoscopic stent therapy in patients with chronic pancreatitis: a 5-year follow-up study. World J Gastroenterol. 2013; 19(5):715-20.PubMedCentralCrossRefPubMed
8.
go back to reference Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, Abrams RA, Laheru D, Hruban RH, Yeo CJ. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—part 3: update on 5-year survival. J Gastrointest Surg. 2005; 9(9):1191-204; discussion 1204-6.CrossRefPubMed Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, Abrams RA, Laheru D, Hruban RH, Yeo CJ. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—part 3: update on 5-year survival. J Gastrointest Surg. 2005; 9(9):1191-204; discussion 1204-6.CrossRefPubMed
9.
go back to reference Bachmann K, Tomkoetter L, Kutup A, Erbes J, Vashist Y, Mann O, Bockhorn M, Izbicki JR. Is the Whipple Procedure Harmful for Long-term Outcome in Treatment of Chronic Pancreatitis? 15-Years Follow-up Comparing the Outcome after Pylorus-Preserving Pancreatoduodenectomy and Frey Procedure in Chronic Pancreatitis. Ann Surg. 2013; 258(5):815-21.CrossRefPubMed Bachmann K, Tomkoetter L, Kutup A, Erbes J, Vashist Y, Mann O, Bockhorn M, Izbicki JR. Is the Whipple Procedure Harmful for Long-term Outcome in Treatment of Chronic Pancreatitis? 15-Years Follow-up Comparing the Outcome after Pylorus-Preserving Pancreatoduodenectomy and Frey Procedure in Chronic Pancreatitis. Ann Surg. 2013; 258(5):815-21.CrossRefPubMed
10.
go back to reference Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis: long-term results in 105 patients. Arch Surg 2000;135:517.CrossRefPubMed Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG, Rowland CM. Pancreatoduodenectomy for chronic pancreatitis: long-term results in 105 patients. Arch Surg 2000;135:517.CrossRefPubMed
11.
go back to reference Croome KP., Farnell M., Que FG., Reid-Lombardo K., Nagorney D., Kendrick ML. Total Laparoscopic Pancreaticoduodenectomy For Pancreatic Ductal Adenocarcinoma: Oncologic Advantages Over Open Approaches? Ann Surg 2014; 260(4):633-8; discussion 638-40.CrossRefPubMed Croome KP., Farnell M., Que FG., Reid-Lombardo K., Nagorney D., Kendrick ML. Total Laparoscopic Pancreaticoduodenectomy For Pancreatic Ductal Adenocarcinoma: Oncologic Advantages Over Open Approaches? Ann Surg 2014; 260(4):633-8; discussion 638-40.CrossRefPubMed
12.
go back to reference Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015; 19(1):189-94; discussion 194.CrossRefPubMed Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg. 2015; 19(1):189-94; discussion 194.CrossRefPubMed
13.
go back to reference Ware JE Jr. How to score version 2 of the SF 12 Health Survey with a supplement documenting version 1. Rhode Island: Quality Metric Incorporated and Boston: Health Assessment Lab, 2002. Ware JE Jr. How to score version 2 of the SF 12 Health Survey with a supplement documenting version 1. Rhode Island: Quality Metric Incorporated and Boston: Health Assessment Lab, 2002.
14.
go back to reference Ware JE, Kosinski M, Keller SD. SF-36 physical and mental summary scales: a user’s manual. Boston, MA: The Health Institute, 1994. Ware JE, Kosinski M, Keller SD. SF-36 physical and mental summary scales: a user’s manual. Boston, MA: The Health Institute, 1994.
15.
go back to reference Pezzilli R, Morselli-Labate AM, Fantini L, Gullo L, Corinaldesi R. Quality of life and clinical indicators for chronic pancreatitis patients in a 2-year follow up study. Pancreas. 2007;34(2):191–196.CrossRefPubMed Pezzilli R, Morselli-Labate AM, Fantini L, Gullo L, Corinaldesi R. Quality of life and clinical indicators for chronic pancreatitis patients in a 2-year follow up study. Pancreas. 2007;34(2):191–196.CrossRefPubMed
16.
go back to reference Mantke R. Lippert H., Buchler MW., Sarr MG. International Practices in Pancreatic Surgery. Berlin: Springer 2013.CrossRef Mantke R. Lippert H., Buchler MW., Sarr MG. International Practices in Pancreatic Surgery. Berlin: Springer 2013.CrossRef
17.
go back to reference Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Gastroenterology 1984; 86: 820–828.PubMed Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Gastroenterology 1984; 86: 820–828.PubMed
18.
go back to reference Miyake H, Harada H, Kunichika K, Ochi K, Kimura I. Clinical course and prognosis of chronic pancreatitis. Pancreas 1987; 2:378–385.CrossRefPubMed Miyake H, Harada H, Kunichika K, Ochi K, Kimura I. Clinical course and prognosis of chronic pancreatitis. Pancreas 1987; 2:378–385.CrossRefPubMed
19.
go back to reference Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993; 54:148–155.CrossRefPubMed Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993; 54:148–155.CrossRefPubMed
20.
go back to reference Cavallini G, Frulloni L, Pederzoli P, Talamini G, Bovo P, Bassi C, Di Francesco V, Vaona B, Falconi M, Sartori N, Angelini G, Brunori MP, Filippini M. Long-term follow-up of patients with chronic pancreatitis in Italy. Scand J Gastroenterol. 1998; 33(8):880-9.CrossRefPubMed Cavallini G, Frulloni L, Pederzoli P, Talamini G, Bovo P, Bassi C, Di Francesco V, Vaona B, Falconi M, Sartori N, Angelini G, Brunori MP, Filippini M. Long-term follow-up of patients with chronic pancreatitis in Italy. Scand J Gastroenterol. 1998; 33(8):880-9.CrossRefPubMed
21.
go back to reference Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, Yekebas E, Kuechler T, Bloechle C, Izbicki JR. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology. 2008; 134(5):1406-11CrossRefPubMed Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, Yekebas E, Kuechler T, Bloechle C, Izbicki JR. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology. 2008; 134(5):1406-11CrossRefPubMed
22.
go back to reference Keck T, Marjanovic G, Fernandez-del Castillo C, Makowiec F, Schäfer AO, Rodriguez JR, Razo O, Hopt UT, Warshaw AL. The inflammatory pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronic pancreatitis determine very different surgical strategies. Ann Surg 2009; 249:105–110.CrossRefPubMed Keck T, Marjanovic G, Fernandez-del Castillo C, Makowiec F, Schäfer AO, Rodriguez JR, Razo O, Hopt UT, Warshaw AL. The inflammatory pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronic pancreatitis determine very different surgical strategies. Ann Surg 2009; 249:105–110.CrossRefPubMed
23.
go back to reference Keck T, Adam U, Makowiec F, Riediger H, Wellner U, Tittelbach-Helmrich D, Hopt UT. Short- and long-term results of duodenum preservation versus resection for the management of chronic pancreatitis: a prospective, randomized study. Surgery. 2012; 152(3 Suppl 1):S95-S102.CrossRefPubMed Keck T, Adam U, Makowiec F, Riediger H, Wellner U, Tittelbach-Helmrich D, Hopt UT. Short- and long-term results of duodenum preservation versus resection for the management of chronic pancreatitis: a prospective, randomized study. Surgery. 2012; 152(3 Suppl 1):S95-S102.CrossRefPubMed
24.
go back to reference Muller MW, Friess H, Martin DJ, Hinz U, Dahmen, Buchler, MW: Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg. 2008; 95(3):350-6.CrossRefPubMed Muller MW, Friess H, Martin DJ, Hinz U, Dahmen, Buchler, MW: Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg. 2008; 95(3):350-6.CrossRefPubMed
25.
go back to reference Walsh RM, Saavedra JR, Lentz G, Guerron AD, Scheman J, Stevens T, Trucco M, Bottino R, Hatipoglu B. Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. J Gastrointest Surg. 2012; 16(8):1469-77.CrossRefPubMed Walsh RM, Saavedra JR, Lentz G, Guerron AD, Scheman J, Stevens T, Trucco M, Bottino R, Hatipoglu B. Improved quality of life following total pancreatectomy and auto-islet transplantation for chronic pancreatitis. J Gastrointest Surg. 2012; 16(8):1469-77.CrossRefPubMed
Metadata
Title
Pancreatoduodenectomy for Chronic Pancreatitis—Results of a Pain Relief and Quality of Life Survey 15 Years Following Operation
Publication date
01-12-2015
Published in
Journal of Gastrointestinal Surgery / Issue 12/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-015-2928-7

Other articles of this Issue 12/2015

Journal of Gastrointestinal Surgery 12/2015 Go to the issue