Organerhaltende Chirurgie bei chronischer Pankreatitis — Langzeitresultate einer prospektiv randomisierten Studie zum Vergleich der subtotalen Resektion (SR) mit der erweiterten Drainage (ED)

Abstract

Background: Resection and drainage are the two basic surgical principles of surgery for chronic pancreatitis (CP). Organ preserving procedures are claimed to offer advantages regarding exocrine and endocrine function. Duodenum preserving subtotal pancreatic head resection (SR) and limited pancreatic head excision combined with longitudinal pancreatico-jejunostomy (ED) have been evaluated in a randomized trial. SR displayed higher hospital morbidity (32% vs. 22%), but short term results did not reveal significant differences between SR and ED. Long-term results, however, are still pending. The aim of this study was to compare SR vs. ED regarding their long-term outcome. Patients and Methods: In total, 74 patients suffering from chronic pancreatitis were randomly divided into SR (n = 38) and ED (n = 36). Before and after the operation, the following parameters were assessed: mortality, morbidity, pain (validated established pain score), quality of life (QL), exo- and endocrine function, working and social rehabilitation. Results: Median follow- up was 6 years (4 – 7.5). There was no significant difference in pancreatitis-associated late mortality (16% vs. 14%) or morbidity (8% vs. 5%). The pain score was significantly higher in SR (25 vs. 5; p = 0.009), but no significant difference was found regarding QL (global QL 66.7 vs. 62.5), exocrine (80% vs. 64%) or endocrine insufficiency (58% vs. 40%), and working/social rehabilitation (100%). Continued alcohol intake was not correlated to recurrent pain (r = 0.67). Conclusion: Lower postoperative morbidity and better results regarding long-term pain control favour ED over SR for CP.