Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis?

Sawyer, Russell P.; Frey, Charles F.

doi:10.1016/s0002-9610(05)80061-3

Cited by 66 publications

(40 citation statements)

References 18 publications

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“…[1][2][3][4] The frequency of resection of the distal pancreas has not risen as dramatically during this period, primarily because of the relative infrequency of resectable malignant pancreatic neoplasms involving the body and tail of the gland [5][6][7] and a general dissatisfaction with distal resection for the management of chronic pancreatitis. 8,9 The purpose of this report is to review a single high-volume institution's experience with distal pancreatectomy and to define the current indications and short-term outcome associated with the procedure.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…8,9 Rattner et al 8 have concluded that even when chronic pancreatitis appears to involve primarily the body and tail of the pancreas, distal pancreatectomy seldom provides sustained pain relief. Similarly, Sawyer and Frey 9 have concluded that distal pancreatectomy is indicated in only 5% to 15% of patients with chronic pancreatitis. Although in their experience 90% of patients with disease limited to the body and tail of the gland had good results in terms of pain relief, nutrition, and preservation of endocrine function, follow-up was limited and long-term outcome remains in question.…”

Section: Discussionmentioning

confidence: 99%

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Distal Pancreatectomy: Indications and Outcomes in 235 Patients

et al. 1999

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ObjectiveDistal pancreatectomy is performed for a variety of benign and malignant conditions. In recent years, significant improvements in perioperative results have been observed at highvolume centers after pancreaticoduodenectomy. Little data, however, are available concerning the current indications and outcomes after distal pancreatectomy. This single-institution experience reviews the recent indications, complications, and outcomes after distal pancreatectomy. MethodsA retrospective analysis was performed of the hospital records of all patients undergoing distal pancreatectomy between January 1994 and December 1997, inclusive. ResultsThe patient population (n ϭ 235) had a mean age of 51 years, (range 1 month to 82 years); 43% were male and 84% white. The final diagnoses included chronic pancreatitis (24%), benign pancreatic cystadenoma (22%), pancreatic adenocarcinoma (18%), neuroendocrine tumor (14%), pancreatic pseudocyst (6%), cystadenocarcinoma (3%), and miscellaneous (13%). The level of resection was at or to the left of the superior mesenteric vein in 96% of patients. A splenectomy was performed in 84% and a cholecystectomy in 15% of patients. The median intraoperative blood loss was 450 ml, the median number of red blood cell units transfused was zero, and the median operative time was 4.3 hours. Two deaths occurred in the hospital or within 30 days of surgery for a perioperative mortality rate of 0.9%. The overall postoperative complication rate was 31%; the most common complications were new-onset insulin-dependent diabetes (8%), pancreatic fistula (5%), intraabdominal abscess (4%), small bowel obstruction (4%), and postoperative hemorrhage (4%). Fourteen patients (6%) required a second surgical procedure; the most common indication was postoperative bleeding. The median length of postoperative hospital stay was 10 days. Patients who underwent a distal pancreatectomy with splenectomy (n ϭ 198) had a similar complication rate (30% vs. 29%), operative time (4.6 vs. 5.1 hours), and intraoperative blood loss (500 vs. 350 ml) and a shorter postoperative length of stay (13 vs. 21 days) than the patients who had splenic preservation (n ϭ 37). ConclusionsThis series represents the largest single-institution experience with distal pancreatectomy. These data demonstrate that elective distal pancreatectomy is associated with a mortality rate of Ͻ1%. These results demonstrate that, as with pancreaticoduodenectomy, distal pancreatectomy can be performed with minimal perioperative mortality and acceptable morbidity.Distal pancreatectomy is a term applied to resection of that portion of the pancreas extending to the left of the midline and not including the duodenum and distal bile duct. Distal pancreatectomy is performed for various indications, including benign inflammatory conditions and benign and malignant neoplasms. In the past decade, pancreaticoduodenectomy, or resection of the head of the pancreas, has been performed with increased frequency because of a marked reduction in procedure-related morbidity an...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Distal Pancreatectomy: Indications and Outcomes in 235 Patients

et al. 1999

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“…This may be due to poor patient selection. When DP was performed with strict indication for predominantly left-side disease, obstructive chronic pancreatitis or large pseudocyst [302,303] pain relief was found in 88−90% of patients. Moreover, DP is mandatory in the suspicion of tail cancer or for a pseudocyst with concomitant bleeding.…”

Section: S11mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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“…However, rare cases of CP in the pancreatic body or tail can be successfully treated by distal pancreatectomy [57,58], while reports of total pancreatectomy in CP have shown overall poor results [59,60].…”

Section: Resectional Proceduresmentioning

confidence: 99%

Surgery for Chronic Pancreatitis

Perwaiz¹,

Singh²,

Chaudhary³

2011

Indian J Surg

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Chronic pancreatitis (CP) is progressive inflammatory process of the pancreas. Abdominal pain remains the most debilitating symptom affecting quality of life, apart from diabetes mellitus, steatorrhoea and weight loss. The treatment options have evolved over the past decades and are aimed to provide durable relief in pain with possible attempt to support or improve the failing endocrine and exocrine functions. Surgical treatment options have shown the potentials to provide superior long term results compared to the pharmacological and endoscopic modalities and are broadly divided in to drainage, resection and combination hybrid procedures. The choice is based on the morphology of the main pancreatic duct, presence of head mass and associated complication of CP. Knowing the basic nature of the disease, total pancreatectomy seems a curative option but not without significant morbidities. There is recent paradigm shift towards organ sparing surgical procedures with reasonable success. Despite recent advancement in the treatment modalities for CP the overall quality of life remains moderate which need further addressal.

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Is there still a role for distal pancreatectomy in surgery for chronic pancreatitis?

Cited by 66 publications

References 18 publications

Distal Pancreatectomy: Indications and Outcomes in 235 Patients

Distal Pancreatectomy: Indications and Outcomes in 235 Patients

Italian consensus guidelines for chronic pancreatitis

Surgery for Chronic Pancreatitis

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