This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Major resection for chronic pancreatitis in patients with vascular involvement is associated with increased postoperative mortality. BJS 2004; 91: 1020-1026.
Published: 14th May 2004
Authors: N. Alexakis, R. Sutton, M. Raraty, S. Connor, P. Ghaneh, M. L. Hughes et al.
Background
The aim was to evaluate the outcome of major resection for chronic pancreatitis in patients with and without vascular involvement.
Method
Of 250 patients with severe chronic pancreatitis referred between 1996 and 2003, 112 underwent pancreatic resection. The outcome of 17 patients (15·2 per cent) who had major vascular involvement was compared with that of patients without vascular involvement.
Results
The 95 patients without vascular involvement had resections comprising Beger's operation (39 patients), Kausch–Whipple pancreatoduodenectomy (28), total pancreatectomy (25) and left pancreatectomy (three). Twenty‐five major vessels were involved in the remaining 17 patients. One or more major veins were occluded and/or compressed producing generalized or segmental portal hypertension, and three patients also had major arterial involvement. Surgery in these patients comprised Beger's operation (eight), total pancreatectomy (five), Kausch–Whipple pancreatoduodenectomy (two) and left pancreatectomy (two). Perioperative mortality rates were significantly different between the groups (two of 95 versus three of 17 respectively; P = 0·024). There were similar and significant improvements in long‐term outcomes in both groups.
Conclusion
Resection for severe chronic pancreatitis in patients with vascular complications is hazardous and is associated with an increased mortality rate. Vascular assessment should be included in the routine follow‐up of patients with chronic pancreatitis, to enable early identification of those likely to develop vascular involvement and prompt surgical intervention. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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