Results of partial and total pancreaticoduodenectomy in 117 patients with chronic pancreatitis

Abstract

This is a report of 117 pancreaticoduodenectomies performed for chronic pancreatitis, of which 49 were partial and 68 were total. The operative mortality rate of partial pancreaticoduodenectomy was 8.2% and of total pancreatectomy was 20.6%. During a follow-up period of 61/2 years, 76% and 63% of the surgical patients, respectively, continued to drink alcohol as heavily as before. Prior to total pancreatectomy, only 42% of the patients had diabetes. After total extirpation of the organ, all had diabetes and 75% were very difficult to stabilize with insulin, experiencing repeated episodes of hypoglycemic shock. The additional late mortality rate was 20.4% following partial pancreaticoduodenectomy and 19.1% after total resection. After total pancreatectomy, 50% of the late deaths were due to hypoglycemia. After total pancreatectomy, 11% fewer patients were still alive at the end of the follow-up period than after partial pancreaticoduodenectomy. Total pancreatectomy is justified only in patients who already have diabetes requiring insulin. A new technique is described in which, following resection of the head of the pancreas, the duct system is occluded by injection of a rapidly hardening amino acid solution, leading to atrophy of the excretory pancreas within a few weeks. This procedure has been carried out in 39 patients with a mortality rate of 2.5% and postoperative complications in 7.6%. We believe that the immediate risk of partial pancreaticoduodenectomy in chronic pancreatitis can be decreased markedly and the late results improved by this new technique.

Pancreatogenic Diabetes: Special Considerations for Management

“…This is particularly true for patients with apancreatic diabetes caused by total or subtotal pancreatectomy [13,52]. In addition, lethal episodes of hypoglycemia are common in severe apancreatic diabetes, caused by hypoglycemic unresponsiveness, due to the absence of pancreatic glucagon, and hypoglycemia unawareness, despite an ongoing need to treat with exogenous insulin [4,53]. Without insulin treatment, patients with apancreatic diabetes become progressively more hyperglycemic and have the same incidence of retinal and renal disease as T1DM patients due to chronically elevated levels of glycosylated proteins [54].…”

Follow-Up Results of Surgical Treatment in Chronic Pancreatitis

“…The rate of mortality was dependent on the type of operation performed. Coinciding with the experience of others [6,15,16] most of the patients (13) died during the first 3 years after operation. The best survival rate was ob served after resections: 3 (7.5%) of 40 patients died after these interventions (1 after total pancreatectomy, 2 after Whipple's procedure).…”

Strategies in Preventing Diabetes after Pancreatectomy Using Islet Auto- and Allo-Transplantation

“…It results in total pancreatic endocrine and exocrine deficiency associated with a variety of deleterious metabolic complications including those directly related to postsurgical diabetes [18,19]. Gall, et al reported long term follow up in 117 patients who underwent total pancreatectomy for chronic pancreatitis reporting 19.1% mortality at 6.5 years with many late deaths caused by hypoglycemia [20]. In the 1970s, Najarian, et al described the total pancreatectomy with islet autotransplantation (TP-IAT) in which pancreatic islets were isolated from the harvested organ and infused into the portal vein to attenuate the postsurgical diabetes [21].…”