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Resection of the pancreatic head with or without gastrectomy

World Journal of Surgery volume 19, pages 403–409 (1995)Cite this article

Abstract

Early and late results of proximal pancreatoduodenectomy were determined in a personal and consecutive series of 100 patients (64 men, 36 women, mean age 51.9 years). Final diagnoses were chronic pancreatitis in 35, idiopathic bile duct stricture in 1, carcinoma of the head of pancreas in 27, and other periampullary tumors in 37 (duodenal carcinoma 11, ampullary carcinoma 11, neuroendocrine tumor 10, cholangiocarcinoma 5). Mean follow-up period was 30.5 months (range 3.5–132.0 months). Resection was conventional (including distal gastrectomy) in 39 patients and conservative (retaining the stomach, pylorus, and duodenal cap) in 61 patients. Resection for inflammatory disease caused greater operative blood loss (mean 2.29 versus 1.75 L; p=0.054) and a longer operative time (6.2 versus 5.2 hours; p=0.040) than resection for neoplastic disease. There were four operative deaths, two from leakage of the pancreatic anastomosis; another two patients survived pancreatojejunostomy leaks. Twenty patients developed postoperative complications, seven of whom required reoperation. Good pain relief was obtained in 76% of patients with chronic pancreatitis, but five required completion distal pancreatectomy at a mean 22.8 months after the first resection. Mean survival of patients with pancreatic cancer was 13.2 months. Sixteen patients with other periampullary cancers are still alive 41.6 months after the operation.

Résumé

Les résultats précoces èt tardifs d'une série consécutive, personnelle, de 100 patients (64 hommes, 36 femmes, âge moyen = 51.9 ans) ayant eu une pancréatectomie proximale sont présentés. II s'agit (diagnostic final) de pancréatite chronique dans 35 cas, de sténose biliaire idiopathique dans un cas, de cancer de la tête du pancréas dans 27 cas, et d'autres tumeurs périampullaires dans 37 cas (cancer duodénal: 11; cancer ampullaire: 11; tumeur neuroendocrine: 10; cholangiocarcinome: 5). Le suivi moyen a été de 30.5 mois (extrêmes: 3.5 à 132 mois). La résection a été conventionnelle (comprenant une gastrectomie distale) chez 39 patients et conservatrice (conservant l'estomac, le pylore et D1) dans 61 cas. Il y a eu plus de perte hémorragique (moyenne 2.29 vs. 1.75 1; p=0.054) et la durée d'intervention était plus longue (6.2 vs. 5.2 heures; p=0.040) en cas de résection pour maladie inflammatoire que lorsqu'il s'agissait de maladie néoplasique. Il y a eu quatre décès opératoires, deux par fuite de l'anastomose pancréatique. Deux autres patients avec fuite anastomotique ont survécu. Vingt patients ont développé des complications postopératoires, parmi lesquels sept ont nécessité une réintervention. Une amélioration de la douleur a été obtenue chez 76% des patients ayant une pancréatite chronique, mais cinq ont nécessité une pancréatectomie distale complémentaire, 22.8 mois en moyenne après la première résection. La survie moyenne des patients ayant un cancer pancréatique à été de 13.2 mois. Seize patients ayant un cancer périampullaire sont encore en vie à 41.6 mois après l'intervention.

Resumen

Se determinaron los resultados tempranos y a largo plazo de la pancreatoduodenectomía proximal en una serie personal y consecutiva de 100 pacientes (64 hombres, 36 mujeres, edad promedio 61.9 años). Los diagnósticos fueron pancreatitis crónica en 35, estrechez idiopática del colédoco en 1, carcinoma de la cabeza del páncreas en 27 y otros tumores periampulares en 37 (carcinoma duodenal 11, carcinoma ampular 11, tumor neoendocrino 10, colangiocarcinoma 5). El período promedio de seguimiento fue 30.5 meses (range 3.5–132.0 meses). La resección fue convencional (incluyendo gastrectomía distal) en 39 pacientes y conservadora (preservando el estómago, el píloro y la primera porción del duodeno en 61 pacientes). La resección por enfermedad inflamatoria causó mayor sangrado operatorio (promedio 2.29 vs 1.75 L; p=0.054) y un tiempo operatorio más prolongado (6.2 vs 5.2 horas; p=0.040) que la resección por enfermedad neoplásica. Se presentaron 4 muertes operatorias, 2 por falla de la anastomosis pancreática; otros 2 pacientes tuvieron fuga de la pancreatoyeyunostomía y sobrevivieron. Veinte pacientes desarrollaron complicaciones postoperatorias, 7 de las cuales requirieron reoperación. Se logró un buen control del dolor en 76% de los pacientes con pancreatitis crónica, pero 5 requirieron completar la pancreatectomía a los 22.8 meses, en promedio, luego de la primera resección. El promedio de sobrevida de los pacientes con cáncer pancreático fue 13.2 meses. Dieciseis pacientes con otros cánceres periampulares se encuentran todavía vivos a los 41.6 meses luego de la operación.

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Author notes

  1. Prasit Watanapa M.D., Ph.D.

    Present address: Department of Surgery, Siriraj Hospital, 10700, Bangkok, Thailand

Affiliations

  1. Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, W12 ONN, London, UK

    Prasit Watanapa M.D., Ph.D. & Robin C. N. Williamson M.D., M.Chir.

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  1. Prasit Watanapa M.D., Ph.D.
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  2. Robin C. N. Williamson M.D., M.Chir.
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Watanapa, P., Williamson, R.C.N. Resection of the pancreatic head with or without gastrectomy. World J. Surg. 19, 403–409 (1995). https://doi.org/10.1007/BF00299172

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  • DOI: https://doi.org/10.1007/BF00299172

Keywords

  • Pancreatitis
  • Chronic Pancreatitis
  • Cholangiocarcinoma
  • Neuroendocrine Tumor
  • Distal Pancreatectomy