Reply to the letter by Markus W. Büchler et al. on our publication “Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreatoduodenectomy”

Ten-year experience with duodenum and organ-preserving pancreatic head resection (Büchler-Farkas modification) in the surgical treatment of chronic pancreatitis

OBJECTIVES

Chronic pancreatitis, a benign, inflammatory process, can cause enlargement of the pancreatic head, which is accompanied by severe pain and weight loss and often leads to a significant reduction in the quality of life (QoL).

METHODS

Our clinical experience relates to the results attained with duodenum and organ-preserving pancreatic head resection in 160 patients during a 10-year period. The QoL is assessed during the follow-up period by using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire.

RESULTS

Two reoperations were required in consequence of anastomosis bleeding and small bowel obstruction, but no mortality was noted in the postoperative period. The duration of hospitalization ranged between 7 and 12 days. The mean follow-up time was 5.3 years (range, 0.5-10.0 years). The late mortality rate was 6.9%. The QoL improved in 89% of the cases. One hundred thirty-three of the patients became complaint-free, whereas 16 displayed moderate symptoms, and the weight increased by a median of 13.4 kg (range, 4-30 kg). The postoperative endocrine functions remained in almost the same stage as preoperatively.

CONCLUSION

Our 10-year experience clearly demonstrates that this duodenum and organ-preserving pancreatic head resection technique is a safe and effective procedure, which should be preferred in the surgical treatment of the complications of chronic pancreatitis.

[Long-term follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis: an 8-year clinical experience]

In one-third of the patients with chronic pancreatitis (CP), enlargement of the pancreatic head develops as a result of inflammatory alterations. A safe procedure has been developed for organ-preserving pancreatic head resection (OPPHR). This report relates to the results attained with OPPHR in 150 patients in an 8-year period. The surgical procedure consists of a wide resection of the inflammatory mass in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, is carried out by a jejunal Roux-en-Y loop. Two reoperations were required as a result of anastomotic bleeding and small bowel obstruction, but no mortality was detected in the postoperative period. The length of hospitalization ranged between 7 and 12 days. The mean follow-up period was 4.5 years (range 0.5-8.0). Late mortality rate was 4%. Quality of life, measured by the EORTC Quality-of-Life Questionnaire during follow-up, improved in 89% of the patients. The 8-year experience clearly reveals that this OPPHR technique is a safe and effective procedure for definitive control of the complications of CP and should be regarded as a recommended procedure in the treatment of CP.

Long-term follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis

In chronic pancreatitis (CP), enlargement of the pancreatic head develops as a result of inflammatory alterations. This report relates to the results attained with an organ-preserving pancreatic head resection (OPPHR) in 135 patients in a 7-year period. The surgical procedure consists of a wide excision of the inflammatory tumor in the region of the pancreatic head, without division and cutting of the pancreas over the portal vein. Reconstruction, with drainage of the secretion from the remaining pancreas into the intestinal tract, takes place through a jejunal Roux-en-Y loop. Only one reoperation was required in consequence to anastomosis bleeding, but no mortality occurred in the postoperative period. The duration of hospitalization ranged between 7 and 12 days. The mean follow-up period was 4.1 years (range, 0.5-7.0). The late mortality rate was 3.7%. The quality of life, measured during the follow-up by using EORTC Quality-of-Life Questionnaire, improved in 89% of the patients. One hundred sixteen patients became complaint-free, while 14 patients had moderate symptoms; the weight increased by a median of 11.3 kg (range, 4-28). The 7-year experience clearly reveals that this OPPHR technique is a safe and effective procedure for definitive control of the complications of CP.