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

• Published in: HPB (Oxford, England) Vol. 11; no. 8; pp. 677 - 683
• Main Authors: McClaine, Rebecca J., Lowy, Andrew M., Matthews, Jeffrey B., Schmulewitz, Nathan, Sussman, Jeffrey J., Ingraham, Angela M., Ahmad, Syed A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-12-2009; Blackwell Publishing Ltd
• Subjects: chronic pancreatitis; duodenum-preserving head resection; Original; pancreaticoduodenectomy; pancreaticoduodenectomy; duodenum-preserving head resection; chronic pancreatitis
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/j.1477-2574.2009.00118.x

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.
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).
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 (360min vs. 245min), duration of hospital stay (12.0 days vs. 9.5 days) and estimated blood loss (535ml vs. 214ml) 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.
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.