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

Sheel, ARG, Baron, RD, Dickerson, LD ORCID: 0000-0001-6281-8658, Ghaneh, P, Campbell, F, Raraty, MGT, Yip, V, Halloran, CM ORCID: 0000-0002-5471-4178 and Neoptolemos, JP (2019) The Liverpool duodenum-and spleen-preserving near-total pancreatectomy can provide long-term pain relief in patients with end-stage chronic pancreatitis. LANGENBECKS ARCHIVES OF SURGERY, 404 (7). pp. 831-840. ISSN 1435-2443, 1435-2451

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Abstract

<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>Duodenum-and spleen-preserving near-total pancreatectomy provided long-term relief in adult patients with intractable chronic pancreatitis pain, with improved employment prospects.

Item Type:	Article
Uncontrolled Keywords:	Chronic pancreatitis, Total pancreatectomy, Duodenum-preserving, Spleen-preserving, Total pancreatectomy, Surgery, Hereditary pancreatitis
Depositing User:	Symplectic Admin
Date Deposited:	30 Jan 2020 08:45
Last Modified:	07 Dec 2024 19:10
DOI:	10.1007/s00423-019-01837-3
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3072515