Patient Reported Outcomes of Duodenum-Preserving Pancreatic Head Resection in Chronic Pancreatitis: High Effectivity is Impaired by Prolonged Non-Surgical Management

BackgroundChronic pancreatitis (CP) causes suffering and socioeconomic burden. This study evaluated perioperative results and patient-reported outcomes (PRO) in CP patients treated with duodenum-preserving pancreatic head resection (DPPHR).MethodsData were analyzed of patients undergoing DPPHR between 01/2001-10/2014. PROs were measured using a specifically designed questionnaire and the EORTC QLQ-C30/PAN26 modules. Associations between treatment variables and PROs were examined.ResultsOf 332 patients who received DPPHR for CP, most (n=251, 75.6%) underwent the Berne modification. Surgical morbidity was 21.5% (n=71) and 90-day mortality was 1.5% (n=5). Median follow-up was 79.9 months, 5-year survival rate 90.5%, and 1.8% of patients developed pancreatic cancer. Of 283 patients alive, 178 (62.9%) returned questionnaires. Referral for surgery was self-initiated (38.0% of cases), by gastroenterologists (27.5%) and by general practitioners (21.1%). QoL improved in 78.7% of patients, remained stable in 12.1%, and worsened in 9.1%. Median Izbicki pain scores decreased from 90 to 5 points after surgery (p<0.0001). Time from diagnosis to DPPHR was an independent, proportional predictor of a higher postoperative Izbicki score (p=0.04).ConclusionDPPHR is an effective, safe treatment for CP. A delay in surgery decreases surgical effectivity, hence CP patients should be referred to surgery early to ensure satisfactory outcomes.