Duodenum-preserving Pancreatic Head Resection Group Research Articles

Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study

Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.

Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: Asystematic review and network meta-analysis of surgical outcomes.

In this systemic review and network meta-analysis, we investigated pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and different modifications of duodenum-preserving pancreatic head resection (DPPHR) to evaluate the efficacy of different surgical procedures. A systemic search of six databases was conducted to identify studies comparing PD, PPPD, and DPPHR for treating pancreatic head benign and low-grade malignant lesions. Meta-analyses and network meta-analyses were performed to compare different surgical procedures. A total of 44 studies were enrolled in the final synthesis. Three categories of a total of 29 indexes were investigated. The DPPHR group had better working ability, physical status, less loss of body weight, and less postoperative discomfort than the Whipple group, while both groups had no differences inquality of life (QoL), pain scale scores, and other 11 indexes. Network meta-analysis of a single procedure found that DPPHR had a larger probability of best performance in seven of eight analyzed indexes than PD or PPPD. DPPHR and PD/PPPD have equal effects on improving QoL and pain relief, while PD/PPPD has more severe symptoms and more complications after surgery. PD, PPPD, and DPPHR procedures exhibit different strengths in treating pancreatic head benign and low-grade malignant lesions. https://www.crd.york.ac.uk/prospero/, identifier: CRD42022342427.

Significant positive impact of duodenum-preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis.

This study aimed to compare the incidence of postoperative nonalcoholic fatty liver disease (NAFLD), postoperative cholangitis, and fibrosis-4 (FIB)-4 index in patients who underwent duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) for low-grade malignant tumors and verify the usefulness of DPPHR in preventing the occurrence of these disorders. This retrospective study included 70 patients who underwent PD (n=39) and DPPHR (n=31) between 2006 and 2018 for benign or low-grade malignant tumors. The present study compared the preoperative background, cumulative incidence of postoperative NAFLD and cholangitis, and other biochemical markers, including the FIB-4 index. Subanalysis by propensity score matching (PSM) analysis was conducted to minimize treatment selection bias. In terms of the cumulative incidence of NAFLD, the 5-y incidence was significantly lower in the DPPHR group than in the PD group both before (10% vs 38%, P=.002) and after (13% vs 38%, P=.008) matching. Multivariate analyses identified DPPHR as the only independent preventive factor for postoperative NAFLD (hazard ratio: 0.160, 95% confidence intervals: 0.034-0.76, P=.021). The 5-y cumulative incidence of postoperative cholangitis was significantly higher in the PD group than in the DPPHR group before (51% vs 3%, P < .001) and after (49% vs 4%, P < .001) matching. The FIB-4 index at 12 mo postoperatively was significantly better in the DPPHR group than in the PD group (1.45 vs 2.35, P=.006) before matching. Preservation of the duodenum and bile duct may contribute to preventing long-term postoperative NAFLD and cholangitis, and liver fibrosis for benign or low-grade malignant pancreatic head tumors.

Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial

There is substantial uncertainty regarding the optimal surgical treatment for chronic pancreatitis. Short-term outcomes have been found to be better after duodenum-preserving pancreatic head resection (DPPHR) than after partial pancreatoduodenectomy. Therefore, we designed the multicentre ChroPac trial to investigate the long-term outcomes of patients with chronic pancreatitis within 24 months after surgery. This randomised, controlled, double-blind, parallel-group, superiority trial was done in 18 hospitals across Europe. Patients with chronic pancreatitis who were planned for elective surgical treatment were randomly assigned to DPPHR or partial pancreatoduodenectomy with a central web-based randomisation tool. The primary endpoint was mean quality of life within 24 months after surgery, measured with the physical functioning scale of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. Primary analysis included all patients who underwent one of the assigned procedures; safety analysis included all patients who underwent surgical intervention (categorised into groups as treated). Patients and outcome assessors were masked to group assignment. The trial was registered, ISRCTN38973832. Recruitment was completed on Sept 3, 2013. Between Sept 10, 2009, and Sept 3, 2013, 250 patients were randomly assigned to DPPHR (n=125) or partial pancreatoduodenectomy (n=125), of whom 226 patients (115 in the DPPHR group and 111 in the partial pancreatoduodenectomy group) were analysed. No difference in quality of life was seen between the groups within 24 months after surgery (75·3 [SD 16·4] for partial pancreatoduodenectomy vs 73·0 [16·4] for DPPHR; mean difference -2·3, 95% CI -6·6 to 2·0; p=0·284). The incidence and severity of serious adverse events did not differ between the groups. 70 (64%) of 109 patients in the DPPHR group and 61 (52%) of 117 patients in the partial pancreatoduodenectomy group had at least one serious adverse event, with the most common being reoperations (for reasons other than chronic pancreatitis), gastrointestinal problems, and other surgical morbidity. No differences in quality of life after surgery for chronic pancreatitis were seen between the interventions. Results from single-centre trials showing superiority for DPPHR were not confirmed in the multicentre setting. German Research Foundation (DFG).

Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials.

Background:Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis.Methods:Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias.Results:Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31–26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94–1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72–1.15, P = 0.41), and endocrine insufficiency (RR = 0.75, 95% CI = 0.52–1.08, P = 0.12). Concerning the follow-up time < 60 months, the DPPHR group had better results of exocrine insufficiency (RR = 0.22, 95% CI = 0.08–0.62, P = 0.04). However, operation time (P < 0.0001), blood transfusion (P = 0.02), hospital stay (P = 0.0002), postoperation morbidity (P = 0.0007), weight gain (P < 0.00001), quality of life (P = 0.01), and occupational rehabilitation (P = 0.007) were significantly better for patients who underwent the DPPHR procedure compared with the PD procedure. The comparison results of the Frey procedure and PD showed that both procedures had an equal effect in the pain relief, postoperation mortality, exocrine and endocrine function, and quality of life (QoL) (P > 0.05), whereas patients who underwent the Frey procedure had significantly reduced operative times (P < 0.05) and less blood transfusions (P < 0.05). Comparing the Beger procedure to the PD procedure, there were no significant differences in hospital stay, blood transfusion, postoperation morbidity or mortality, pain relief, weight gain, exocrine insufficiency, and occupational rehabilitation (P > 0.05). Two studies comparing the Beger and Frey procedures showed no differences in postoperative morbidity, pain relief, exocrine insufficiency, and quality of life (P > 0.05). In terms of operative time, blood transfusion, hospital stay, postoperation morbidity, weight gain, quality of life, and occupational rehabilitation, the results also favored duodenum-preserving pancreatic head resection (DPPHR) strategies.Conclusion:All procedures are equally effective for the management of pain, postoperation morbidity, exocrine insufficiency, and endocrine insufficiency for chronic pancreatitis. Improved short- and long-term outcomes, including operative time, blood transfusion, hospital stay, quality of life, weight gain, and occupational rehabilitation make DPPHR a more favorable surgical strategy for patients with chronic pancreatitis. Further, relevant trails are eager to prove these findings.

Efficacy of duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis combined with pancreatic duct stones: a prospective analysis

Objective To investigate the efficacy of duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis combined with type Ⅰ and Ⅲ pancreatic duct stones.Methods The clinical data of 55 patients with chronic pancreatitis and type Ⅰ and Ⅲ pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 2008 to June 2013 were prospectively analyzed.All the patients were randomly divided into the pancreatoduodenectomy (PD) group (27 patients) and the DPPHR group (28 patients).There were 18 patients with chronic pancreatitis and type Ⅰ pancreatic duct stones and 9 patients with chronic pancreatitis and type Ⅲ pancreatic duct stones in the PD group.There were 16 patients with chronic pancreatitis and type Ⅰ pancreatic duct stones and 12 patients with chronic pancreatitis and type Ⅲ pancreatic duct stones in the DPPHR group.Patients in the PD group received PD + Child anastomosis + end-toside pancreato jejunal anastomosis + pancreatic stent placement + end-to-side cholangiojejunostomy.Patients in the DPPHR group received free of duodenum + pancreatic duct incision + resection of pancreas at 1 cm ahead of the pancreatic duct + extraction of the pancreatic duct stones + pancreaticoduodenal Roux-en-Y anastomosis.Patients were followed up via out-patient examination till December 2013.The measurement data were analyzed using the t test or Mann-Whitney U test,and the count data were analyzed using the chi-square test.Results During the operation,2 patients in the PD group were converted to the DPPHR group and 1 patient in the DPPHR group was converted to the PD group.No patient died during the perioperative period,and the symptoms including abdominal pain and diarrhea were alleviated at postoperative week 2.The operation time,blood loss,duration of postoperative hospital stay,total expenses and incidence of complications were (7.5 ± 1.6) hours,(460 ± 88) mL,(18.0 ± 3.5) days,(7.8 ± 2.1) × 104 yuan,19.2％ (5/26) in the PD group,and (4.0 ± 1.0) hours,(120 ± 36) mL,(9.5 ± 2.9) days,(3.9 ± 1.2) × 104 yuan,3.4％ (1/29) in the DPPHR group,there were no significant differences in the operation time,blood loss,duration of hospital stay,total expenses and incidence of complications between the 2 groups (t =9.358,11.365,6.325,8.647,x2 =3.976,P ＜ 0.05).Fifty-three patients were followed up,with the median time of 33 months (range,6 months to 5 years).No patient died during the follow-up.Twenty-four patients in the PD group were followed up,2 patients had slight abdominal pain,1 patient had severe abdominal pain due to pancreatic duct stenosis,and the symptom was alleviated after resection of partial pancreas ; the condition of 12 patients was improved among the 19 patients with diabetes.Twenty-nine patients in the DPPHR group were followed up,2 patients had slight pain; the condition of 16 patients were improved among the 22 patients with diabetes.Conclusion DPPHR is an ideal surgical procedure for patients with chronic pancreatitis and type Ⅰ and Ⅲ pancreatic duct stones. Key words: Chronic pancreatitis ; Pancreatic duct stones; Typing; Duodenum-preserving pancreatic head resection; Pancreatoduodenectomy

A meta-analysis of the long-term effects of chronic pancreatitis surgical treatments: duodenum-preserving pancreatic head resection versus pancreatoduodenectomy

Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis (CP). Two major strategies exist: duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD). Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however, the long-term effects have not been thoroughly investigated. We analyzed the long-term outcomes of DPPHR and PD, over follow-up times of at least 1 year, to determine the optimal surgical treatment for CP. Methods We systemically reviewed all CP surgical treatment reports, and only included randomized controlled trials (RCT) comparing DPPHR and PD, excluding unqualified studies using several pre-specified criteria. When multiple publications of a single trial were found, the most comprehensive current data were selected. Characteristics of the study populations and long-term postoperative outcome parameters were collected. The quality of the studies and data was analyzed using RevMan 4.2 software. Results Five trials were qualified for meta-analysis, with 261 participants in total (114 in the DPPHR group and 147 in the PD group). There were no significant differences in the age, gender, or indications for surgery of each group. At the mean of 5.7-year (1-14 years) follow-up examination, DPPHR and PD resulted in equally effective pain relief, exocrine and endocrine function, and similar mortality rates (P &gt;0.05); however, DPPHR patients had improved global quality of life and weight gain, and reduced diarrhea and fatigue (P &lt;0.05). Conclusion DPPHR and PD result in equal pain relief, mortality, and pancreatic function; however, DPPHR provides superior long-term outcomes.

Duodenum-Preserving Pancreatic Head Resection vs. Pancreatoduodenectomy for Benign Lesions and Low-Grade Malignancies of the Pancreatic Head

To compare the postoperative results of duodenum-preserving pancreatic head resection (DPPHR) techniques with those of conventional pancreatoduodenectomy (PD). We retrospectively reviewed the records of 58 patients who underwent DPPHR or PD at Jinhua central hospital between May 1998 and May 2011. Eighteen patients underwent DPPHR (Group 1) and 40 conventional PD (Group 2). They were followed up for more than 6 months. Operation time in Group 1 was longer (290±18 min vs 269±14 min, p=0.001). Estimated blood loss in Group 1 was more (633±88 mL vs. 495±131 mL, p=0.003). Intraoperative transfusion in Group 1 was more (533±88 mL vs. 335±218 mL, p=0,001). However, postoperative transfusion was Iess (141±162 mL vs. 440±193 mL, p=0.000). Group 1 had a lower short-term complication rate (16.67% vs. 50.0%, p=0.0 16) and long-term complication rate (11.11% vs. 45.0%, p=0.012). Hospital mortality of both groups were 0. DPPHR for benign or premalignant lesions is a difficult procedure, but with a lower complication rate than conventional PD. Preserving the entire duodenum and a normal biliary tree allows better short-term and long-term results. DPPHR will be suitable for only a small group of patients and should be performed by experienced surgeons.

Pancreaticoduodenectomy Versus Duodenum-Preserving Pancreatic Head Resection for the Treatment of Chronic Pancreatitis

The objective of this study was to assess the efficacy and safety of pancreaticoduodenectomy (PD) and duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis (CP). The 123 patients with CP who underwent pancreatic head resection between January 2004 and June 2009 were retrospectively analyzed. The preoperative variables, operative data, postoperative complications, and follow-up information were examined. There were no significant differences in clinical and morphological characteristics, pain relief, and jaundice status between the PD and DPPHR groups. The duration of operation was shorter (251.8 [SD, 43.1] vs 324.5 [SD, 41.4] minutes, P < 0.001), blood loss was less (464.4 [SD, 203.6] vs 646.5 [SD, 242.9] mL, P < 0.001), and overall postoperative morbidity was lower (3% vs 19%, P = 0.006) in DPPHR group. The duration of hospital stay was also significantly different (9.9 [SD, 1.8] vs 13.7 [SD, 2.8] days, P < 0.001). Most functional and symptom scales revealed a better quality of life in DPPHR group. The proportion of patients with exocrine and endocrine insufficiency was higher in PD group as compared with DPPHR group. Both procedures are equally effective in pain relief, but DPPHR is superior to PD in operative data, postoperative morbidity, improving quality of life, and preservation of exocrine and endocrine function.

Duodenum‐preserving versus pylorus‐preserving pancreatic head resection for benign and premalignant lesions

Pylorus-preserving pancreaticoduodenectomy (PPPD) is the treatment of choice for benign or premalignant pancreatic head lesions. Duodenum-preserving pancreatic head resection (DPPHR) has been reported in only 132 patients. This study aimed to compare the long-term results of DPPHR and PPPD. Patients who underwent DPPHR or PPPD for benign or borderline disease between 1991 and 2008 were followed up until December 2009 or their death. Endocrine and exocrine pancreatic functions were evaluated at their last follow-up. Twenty-seven patients underwent DPPHR (Group 1) and 37 PPPD (Group 2). They were followed for a mean of 100 and 135 months, respectively. Group 1 had a higher complication rate (81.5 vs. 40.5%) and pancreatic fistula rate (40.1 vs. 18.9%). Hospital mortality was 0 and 2.7%, respectively. Two patients died 3.3 and 97 months after DPPHR. Significantly more Group 2 patients needed medical treatment for benign cholangitis (P < 0.0001). Insulin-dependent diabetes mellitus was observed in six Group 1 and 15 Group 2 patients (P = 0.077). Ten Group 1 and 21 Group 2 patients are taking pancreatic enzymes (P = 0.003). DPPHR for benign or premalignant lesions is a difficult procedure with a higher complication rate than PPPD, but was without mortality. Preserving the entire duodenum and a normal biliary tree allows better long-term results.

Five-year follow-up of a prospective non-randomised study comparing duodenum-preserving pancreatic head resection with classic Whipple procedure in the treatment of chronic pancreatitis

Three prospective randomised studies were conducted to compare pancreatoduodenectomy (PD) with duodenum-preserving pancreatic head resection (DPPHR) in patients suffering from chronic pancreatitis (cP). In these three series, the superiority of the duodenum-preserving technique with regard to quality of life (QOL) and pain relief has been demonstrated. Long-term follow-up investigations have not been published so far. The present paper reports on a 5-year follow-up study of a prospective, non-randomised trial comparing classic Whipple procedure (PD) with Beger DPPHR. Seventy patients were initially enrolled in this study. Fifty-one patients were left for the present long-term outcome analysis (PD, n = 24; DPPHR, n = 27). The follow-up included the following parameters: QOL, pain intensity, endocrine and exocrine function, and body mass index (BMI). The median follow-up was 63.5 (range 56-67) months. Two patients in the DPPHR group and none in the PD group underwent a re-operation. The QOL scores of the relevant symptom scales (nausea, pain, diarrhoea) and functional parameters (physical status, working ability, global QOL) were significantly better in the DPPHR group than in the PD group. Pain intensity as self-assessed by the patients was less pronounced in the DPPHR group (P < 0.001), whereas the frequency of acute episodes and analgesic medication did not differ between the two groups. No difference was observed between the two groups with regard to endocrine and exocrine function. The values of the median body mass index (BMI) in the PD group [23.4 (range 18.5-25.0) kg/m(2)] and in the DPPHR group [24.2 (range 17.9-27.8) kg/m(2)] were comparable. The 5-year outcome remained stable compared to the early post-operative data published elsewhere. This 5-year long-term outcome analysis documents the superiority of the Beger duodenum-preserving technique over the classic Whipple procedure in terms of QOL and pain intensity as self-assessed by the patients.

Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis

Background. There is no consensus in the surgical management of chronic pancreatitis (cP) as to whether techniques preserving the duodenum are superior to pancreatoduodenectomy. This prospective study compared the outcome of standard pancreatoduodenectomy (PD) and duodenum-preserving pancreatic head resection (DPPHR) in treatment of selected patients with cP. Methods. Inclusion criteria for this prospective controlled, nonrandomized study were patients suffering from cP centered in the head and with severe pain. Seventy consecutive patients underwent DPPHR (n = 38) or, if there was suspicion of malignancy, classic PD (n = 32). A multidimensional, psychometric questionnaire was used to measure the quality of life (QoL). QoL was compared with that of the general German population. Pain intensity was evaluated on the basis of the frequency of pain attacks, analgesic medication, and self-assessed pain score. Assessment of endocrine and exocrine function as well as nutritional status included oral glucose tolerance test, fecal elastase, stool frequency, and body mass index. The median follow-up was 34 months. Results. Multiple clinical characteristics did not differ between the two groups except for age (P =.04), the tumor marker carbohydrate antigen 19-9 (P =.02), and the parameter suspicion of malignancy. There was no hospital mortality. Surgical morbidity was 19% in the PD group and 8% in the DPPHR group (P =.60). PD resulted in a longer median hospital stay than DPPHR (19 vs 15 days, P =.04). Complications of adjacent organs were definitively treated in 100% after PD and in 97% after DPPHR. Postoperative pain intensity as self-assessed by the patients was significantly less in the DPPHR group (P <.001), whereas the frequency of acute episodes (P =.27) and analgesic medication (P =.43) did not differ between the two groups. After surgery, symptom and functional scales of the DPPHR group were significantly better than those in the PD group and were similar to those of the overall German population. No significant difference was found between the two groups with regard to endocrine and exocrine function. Postoperative increase of body mass index was significantly higher in the DPPHR group (P <.001). Conclusions. DPPHR provides better results in the treatment of cP than PD in terms of QoL, pain intensity as self-assessed by the patients, nutritional status, and length of hospital stay. (Surgery 2003;134:53-62.)

Quality of Life in Chronic Pancreatitis: A Prospective Trial Comparing Classical Whipple Procedure and Duodenum-Preserving Pancreatic Head Resection

Few data are available with respect to quality of life after pancreatic head resection in patients with chronic pancreatitis. The aim of this study was to compare the classical Whipple pancreatoduodenectomy (PD) with the Beger duodenum-preserving pancreatic head resection (DPPHR), in terms of quality of life, using standardized, valid, and reliable questionnaires. Sixty-five consecutive patients were included in this study. The PD procedure was chosen when pancreatic cancer could not be ruled out (n = 30); otherwise DPPHR was performed (n = 35). Quality of life was measured prospectively three times with the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30) and the Gastrointestinal Quality-of-Life Index (GIQLI). Both procedures led to a significant improvement in quality of life, especially with regard to pain status. However, at the second follow-up examination (18 to 24 months postoperatively), all functional scales and the most important symptom scales of the EORTC QLQ-C30 revealed a better quality of life in the DPPHR group compared to the PD group. After classical PD, more patients seem to develop diabetes mellitus. The EORTC QLQ-C30 was found to be a better tool for quality-of-life assessment than the GIQLI in patients with chronic pancreatitis. ( J Gastrointest Surg 2002;6:173–180.)