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Vol. 98. Issue 5.
Pages 267-273 (May 2020)
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Vol. 98. Issue 5.
Pages 267-273 (May 2020)
Original article
DOI: 10.1016/j.cireng.2020.04.010
Long-term Results of Resection of the Head of the Pancreas Due to Chronic Pancreatitis: Pancreaticoduodenectomy or Duodenum-preserving Cephalic Pancreatectomy?
Resultados a largo plazo sobre la resección de la cabeza pancreática por pancreatitis crónica: ¿duodenopancreatectomía cefálica o pancreatectomía cefálica con preservación duodenal?
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Sandra Lopez Gordoa, Juli Busquetsb,
Corresponding author
jbusquets@bellvitgehospital.cat

Corresponding author.
, Nuria Peláezb, Lluís Secanellab, Laura Martinez-Carniceroc, Emilio Ramosb, Joan Fabregatb
a Consorcio Sanitario Alt Penedés-Garraf, Sant Pere de Ribes, Barcelona, Spain
b Unitat de Cirurgia Hepatobiliopancreàtica, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
c Servei de Radiodiagnòstic, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Tables (3)
Table 1. Preoperative Assessment.
Table 2. Intraoperative Details and Postoperative Morbidity.
Table 3. Long-term Follow-up.
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Figures (1)
Abstract
Introduction

Chronic pain in chronic pancreatitis is difficult to manage. The objective of our study is to assess the control of pain that is refractory to medical treatment in patients with an inflammatory mass in the head of the pancreas, as well as to compare the two surgical techniques.

Methods

A retrospective study included patients treated surgically between 1989 and 2011 who had been refractory to medical treatment with inflammation of the head of the pancreas. An analysis of the short and long-term results was done to compare patients who had undergone pancreaticoduodenectomy (PD) and/or resection of the head of the pancreas with duodenal preservation (RHPDP).

Results

22 PD and 12 RHPDP were performed. Postoperative complications were observed in 14% of patients, the most frequent being delayed gastric emptying (14.7%) and pancreatic fistula (11.7%). No statistically significant differences were found in terms of surgical technique. Pain control was satisfactory in 85% of patients, 43% presented de novo diabetes mellitus, and 88% returned to their work activities. Fourteen patients died during follow-up, 7 due to malignancies, and some were related to tobacco use and alcohol consumption. The overall 5 and 10 year survival rates were 88% and 75% respectively.

Conclusion

Cephalic resection in patients with intractable pain in chronic pancreatitis is an effective therapy that provides good long-term results in terms of pain control, with no significant differences between the two surgical techniques. Patients with chronic pancreatitis have a high mortality rate associated with de novo malignancies.

Keywords:
Pancreatoduodenectomy
Pancreatectomy with duodenal preservation
Chronic pancreatitis
Long term follow-up
Resumen
Introducción

El dolor crónico en la pancreatitis crónica es de difícil manejo. El objetivo de nuestro trabajo es la valoración del control del dolor refractario al tratamiento médico en pacientes afectos de masa inflamatoria en la cabeza pancreática, así como comparar dos técnicas quirúrgicas realizadas.

Métodos

Estudio retrospectivo sobre pacientes intervenidos entre 1989 y 2011 refractarios al tratamiento médico con predominio inflamatorio en la cabeza pancreática. Se realizó un estudio comparativo a corto y a largo plazo entre los pacientes intervenidos mediante duodenopancreatectomía cefálica (DPC) y/o pancreatectomía cefálica con preservación duodenal (PCPD).

Resultados

Se realizaron 22 DPC y 12 PCPD. En el 44% de los casos se presentaron complicaciones posquirúrgicas, siendo las más frecuentes el vaciamiento gástrico retardado (14,7%) y la fístula pancreática (11,7%). No se evidenciaron diferencias estadísticamente significativas según la técnica quirúrgica. Se consiguió el control del dolor de forma satisfactoria en el 85% de los pacientes, hubo un 43% de diabetes mellitus de novo, y la reincorporación a la actividad laboral fue del 88%. Catorce pacientes fallecieron durante el seguimiento; de ellos, 7 a causa de neoplasias, algunas de ellas relacionadas con el consumo de tabaco y alcohol. La supervivencia global a 5 y 10 años fue del 88 y del 75%, respectivamente.

Conclusión

La resección cefálica en pacientes con dolor intratable en la pancreatitis crónica es una terapéutica eficaz, con buenos resultados a largo plazo en términos de control del dolor y sin diferencias significativas entre ambas técnicas quirúrgicas. Los pacientes con pancreatitis crónica presentan una elevada mortalidad asociada a neoplasias de novo.

Palabras clave:
Duodenopancreatectomía cefálica
Pancreatectomía cefálica con preservación duodenal
Pancreatitis crónica
Seguimiento a largo plazo

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