Background
Duodenum-preserving pancreatic head resections (DPPHRs) have been shown in European
randomized clinical trials to be superior to pancreaticoduodenectomy for chronic pancreatitis,
but DPPHR procedures have been slow to be adopted in the United States.
Methods
To assess national attitudes of surgeons toward DPPHR, a web-based survey was administered
to the U.S. members of the Pancreas Club, which is a national organization of pancreatic
surgeons. We also performed a retrospective review of 21 DPPHRs, performed by the
senior author, for chronic pancreatitis between January 2000 and March 2005.
Results
The web-based national survey was completed by 64 of 118 members of the Pancreas Club
(54.24%). Of the 59 surgeons who perform operations for chronic pancreatitis, 34 had
performed a DPPHR at least once. Only 23 U.S. surgeons continue to perform these procedures.
Most surgeons who are not performing DPPHRs responded that, despite the published
literature, existing procedures such as the Whipple and Puestow were better procedures.
In our clinical series, 12 men and 9 women with a mean age of 48.2 ± 9.6 years underwent
DPPHR. The median length of stay was 9 days with 6 patients (28%) who had complications
in the postoperative period. Ten of 20 potentially evaluable patients completed a
visual analog pain scale and EORTC C-30 quality-of-life questionnaire. Pancreatic
functioning approached the normal range in all domains. As compared with a general
population of patients with chronic pancreatitis, significant improvement occurred
in pancreatic-related pain and digestive function. Self-reported pain was significantly
better after operation than before operation.
Conclusions
DPPHR provides excellent functional results with relatively low postoperative morbidity
and duration of stay. These procedures are underused in the United States, with very
few surgeons who use, teach them, or report their results.
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Article info
Publication history
Accepted:
August 10,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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- ErratumSurgeryVol. 143Issue 2
- PreviewAs a result of a production error, several articles appearing in the Central Surgical Association (Surgery, 2007; Vol. 142, No. 4:433-644) and American Association of Endocrine Surgeons (Surgery, 2007; Vol. 142, No. 6:785-1030) special focus issues were published without their respective discussions. The articles affected have now been updated online to include the missing discussion material. Surgery apologizes to the authors for this significant oversight.
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