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Thierry Berney, MD, MSc; Tatiana Rüdisühli, MD; José Oberholzer, MD; Aileen Caulfield, MD; Philippe Morel, MD

Arch Surg. 2000;135:1106-1111.

Hypothesis  Type and extent of pancreatic resection have little effect on long-term development of diabetes in patients with chronic pancreatitis (CP) considering the distinctive relentless progression of the disease.

Design  A case series of consecutive patients included over a 10-year period. Median duration of follow-up was 6.3 years. Follow-up of survivors was at least 5 years (median, 7.7 years).

Setting  A referral center in a university hospital.

Patients  All 68 patients (57 men and 11 women) who underwent pancreatic resection for CP during the study period were included. Median age of patients was 44 years. Complete follow-up was obtained for all patients.

Interventions  Resection procedures included 35 proximal pancreatoduodenectomies (51%), 31 distal pancreatectomies (46%), and 2 total pancreatoduodenectomies (3%). Four patients (6%) received autologous intraportal islet transplants.

Main Outcome Measures  Time from surgery to introduction of insulin therapy or death, perioperative morbidity and mortality, and pain control.

Results  Fifty-one patients (75%) had experienced acute episodes of CP 5 months to 13 years before resection. Perioperative mortality and morbidity were 1.5% and 21.0%, respectively. Satisfactory long-term pain control was achieved in 61 patients (90%). Actuarial survival was 54% at 10 years and was significantly worse for patients with alcoholic CP (48% vs 78%; P = .04). Diabetes-free survival was 26% at 10 years, with no difference according to type or extent of pancreatic resection.

Conclusions  Pancreatic resection for severe CP is safe and has good long-term results on pain control but is performed late in the course of disease. Earlier resection and islet of Langerhans autotransplantation should be considered for patients who are inexorably heading toward diabetes, regardless of type and extent of resection performed.

From the Clinic of Digestive Surgery and Transplantation Unit (Drs Berney, Rüdisühli, Oberholzer, and Morel) and the Division of Diabetology (Dr Caulfield), Geneva University Hospital, Geneva, Switzerland. Dr Berney is now with the Diabetes Research Institute, University of Miami, Miami, Fla.

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