Langenbeck's Archives of Surgery

, Volume 404, Issue 7, pp 831–840 | Cite as

The Liverpool duodenum-and spleen-preserving near-total pancreatectomy can provide long-term pain relief in patients with end-stage chronic pancreatitis

  • A. R. G. Sheel
  • R. D. Baron
  • L. D. Dickerson
  • P. Ghaneh
  • F. Campbell
  • M. G. T. Raraty
  • V. Yip
  • C. M. Halloran
  • J. P. NeoptolemosEmail author
Original Article



Total pancreatectomy may improve symptoms in patients with severe end-stage chronic pancreatitis. This might be achieved whilst preserving both the duodenum- and spleen-(DPSPTP). Mature clinical outcomes of this approach are presented.


Single-centre prospective cohort study performed between September 1996 and May 2016. Demographic, clinical details, pain scores and employment status were prospectively recorded during clinic attendance.


Fifty-one patients (33 men, 18 women) with a median (interquartile range) age of 40.8 (35.3–49.4) years, a median weight of 69.8 (61.0–81.5) Kg and a median body mass index of 23.8 (21.5–27.8), underwent intended duodenum-and spleen-preserving near-total pancreatectomy for end-stage chronic pancreatitis. Aetiology was excess alcohol in 25, idiopathic (no mutation) in 15, idiopathic (SPINK-1/CFTR mutations) in two, hereditary (PRSS1 mutation) in seven and one each post-necrotising pancreatitis and obstructive pancreatic duct divisum in 1. The main indication for surgery was severe pain. Findings included parenchymal calcification in 79% and ductal calculi in 24%, a dilated main pancreatic duct in 57% and a dilated main bile duct in 17%, major vascular involvement in 27% and pancreato-peritoneal fistula in 2%. Postoperative complications occurred in 20 patients with two deaths. Median pain scores were 8 (7–8) preoperatively and 3 (0.25–5.75) at 5 years (p = 0.013). Opiate analgesic use was significantly reduced postoperatively (p = 0.048). Following surgery, 22 (63%) of 38 patients of working age re-entered employment compared with 12 (33%) working preoperatively (p = 0.016).


Duodenum-and spleen-preserving near-total pancreatectomy provided long-term relief in adult patients with intractable chronic pancreatitis pain, with improved employment prospects.


Chronic pancreatitis Total pancreatectomy Duodenum-preserving Spleen-preserving Total pancreatectomy Surgery Hereditary pancreatitis 



We are grateful to the surgical team and specialist clinical nurses and other health care workers on the Pancreas Unit at the Royal Liverpool University Hospital for supporting this study.

Authors’ contributions

A.R.G. Sheel: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical review of manuscript. R.D. Baron: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical review of manuscript. L.D. Dickerson: acquisition of data, critical review of manuscript. P. Ghaneh: acquisition of data, critical review of manuscript. F. Campbell: acquisition of data, analysis and interpretation of data, critical review of manuscript. M.G.T. Raraty: acquisition of data, critical review of manuscript. C.M. Halloran: acquisition of data, critical review of manuscript. J.P. Neoptolemos: study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical review of manuscript.

Funding information

JPN was a Senior National Institute for Health Research Investigator during the course of the study (NF-SI-0512-10012).

Compliance with ethical standards

Conflict of interest

JPN has received research grants from NUCANA. ARGS has received research grants from the Royal College of Surgeons of England. RDB, PG and CMH have received research grants from Cancer Research UK. LDD, FC, MGTR and VY declare that that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Cancer Medicine, Institute of Translational MedicineThe University of LiverpoolLiverpoolUK
  2. 2.Department of Pancreato-Biliary SurgeryThe Royal Liverpool University HospitalLiverpoolUK
  3. 3.Department of HistopathologyThe Royal Liverpool University HospitalLiverpoolUK
  4. 4.The Royal London Hospital, WhitechapelLondonUK
  5. 5.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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