Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis

Abstract

Background: Duodenum-preserving pancreatic head resection according to Beger and the pyloruspreserving Whipple (ppWhipple) procedure were compared in patients with chronic pancreatitis (CP) in a randomized clinical trial. Perioperative data and short-term outcome have been reported previously. The present study evaluated long-term follow-up.Methods: Forty patients were enrolled originally, 20 in each group. Long-term follow-up included mortality, morbidity, pain status, occupational rehabilitation, quality of life (QoL), and endocrine and exocrine function at median follow-up of 7 and 14 years.Results: One patient who had a ppWhipple procedure was lost to follow-up. There were five late deaths in each group. No differences were noted in pain status and exocrine pancreatic function. Loss of appetite was significantly worse in the ppWhipple group at 14 years' follow-up, but there were no other differences in QoL parameters examined. After 14 years, diabetes mellitus was present in seven of 15 patients who had the Beger procedure and 11 of 14 patients after ppWhipple resection (P = 0·128). Conclusion:After long-term follow-up of up to 14 years early advantages of the Beger procedure were no longer present.

Italian consensus guidelines for chronic pancreatitis

“…Mixed techniques have equal pain relief and better short-term outcome than PD [229,230,293,294] while results in longterm follow-up are similar [295,296].…”

Resection Operations in Surgical Treatment of Patients With Chronic Pancreatitis Complicated by Biliary Hypertension

“…Surgical treatment is indicated in case of clinical signs of CP and morphological changes in the pancreas when conservative therapy is ineffective and there is a threat of CP complications or the complications have already occurred [1]. The task of surgical treatment of CP include: elimination of pain and local complications, preservation and improvement of exocrine and endocrine functions of the pancreas, improvement of the patients' quality of life [12][13][14][15][16].…”

Surgical Treatment of Chronic Pancreatitis

“…The RCTs comparing PD and DPPHR (33,(40)(41)(42)(43)(44) as well as a recent metaanalysis (45) demonstrate comparable mortality and efficacy in terms of pain relief as well as endocrine insufficiency; however, the less invasive DPPHR was superior in hospital stay, exocrine insufficiency, weight gain and quality of life in medium-term follow-up. In even more recent studies with long-term follow-up these metabolic advantages appear to be lost over time and long-term results of PD and DPPHR are equal in terms of pain management and quality of life as well as endocrine and exocrine function (compare results reported in the initial trials and the latest follow-ups in tab.…”

“…If the bile duct is obstructed it can be opened and a internal anastomosis with the excavated pancreatic head can be performed (not shown). The reconstruction is performed with two anastomoses, of the pancreatic tail remnant and of the excavated pancreatic head with a Roux-en-Y jejunal loop The Bern modification of the DPPHR represents a technical simplification of the Begerprocedure with equal outcome (28,33,34,39). The excavation of the pancreatic head can be performed with identical extent compared to the Berger-procedure.…”

“…3). Of interest, the resection techniques remain effective in terms of pain relief and quality of life but cannot stop the progress of exocrine and endocrine insufficiency on the long term (33,44). One explanation may be that resection effectively treats the obstruction and hypertension, but does not completely stop continued to the Beger-procedure.…”