Tratamentul chirurgical al pancreatitei cronice: o experiență de 14 ani a unui singur centru

Abstract

Tratamentul chirurgical al pancreatitei cronice este indicat la pacienții cu durere persistentă în ciuda tratamentului medicamentos sau endoscopic, sau în cazul prezenței complicațiilor.Obiectiv: Acest studiu evaluează experiența unui singur centru în ceea ce privește managementul chirurgical al pancreatitei cronice pe o perioadă de 14 ani, cu privire la indicație,tehnica chirurgicală, rezultate imediate și tardive.Material și metodă: Au fost studiați 265 de pacienți ce au suferit intervenții chirurgicale pentru pancreatita cronicã între anii 1995 și 2008. Rezultatele tardive postoperatorii au fost evaluate prin sondaj direct, cu o urmãrire medianã de 40 de luni.Rezultate: 265 de pacienți au suferit 275 de intervenții chirugicale pentru pancreatita cronicã având ca indicțtie principalã durerea abdominalã (46,8%), urmatã de suspiciunea de malignizare 24,8 % și episoade de pancreatitã acutã recurentã 18,6%. Rezecții 54,5% (150), proceduri de drenaj1,09% (3), derivatii, proceduri de neurolizã 44,36% (122) silaparotomii exploratorii 3,27% (9) au fost efectuate cu o morbiditate totalã de 22 % și o mortalitate imediatã de 2,64%.Dupã o urmãrire medianã de 40 de luni s-au obținut informații pentru 137 de pacienți (51,69%) cu o supraviețuire actuarialã la 5 ani de 74,7% și îmbunãtãțirea calității vieții la majoritatea pacienților, în special la pacienții rezecati. Concluzie: Rezultatele noastre sugereazã că în cazul pancreatitei cronice tipul interventiei chirurgicale trebuie individualizat (rezectie vs drenaj) și operațiile conservatoare (organ sparing) sunt eficiente și sigure în tratamentul pe termen lung al durerii și al complicatiilor pancreatitei cronice. Background: Operative treatment of chronic pancreatitis isindicated for patients with intractable pain after failed medicaland endoscopic treatment, or in the presence of complicationsof the disease.Aims: This study evaluates a single-center experience withoperative management of chronic pancreatitis over a periodof time of 14 years, regarding indication, surgical technique,early and late results.Patients and Methods: The records of 265 consecutive patientswho underwent surgery for chronic pancreatitis between 1995and 2008 were retrospectively reviewed and analyzed. Longtermoutcomes were assessed by patient survey, with a medianfollow-up of 40 months.Results: 265 patients underwent 275 operations for chronicpancreatitis with the main indication abdominal pain(46,8%), followed by suspected malignancy in 24,8 % andrecurrent episodes of acute pancreatitis in 18,6%. Resectionprocedures 54,5% (150), drainage procedures 1,09% (3), bypassand denervation procedures 44,36% (122) andexploratory laparotomy 3,27% (9) were performed with anoverall morbidity of 22 % and an in-hospital mortality rateof 2,64%. After a median follow-up of 40 months survivalinformation was available for 137 patients (51,69%) with aCorresponding author:225-and actuarial survival rate of 74,7% and quality of lifeimprovement in most patients, especially in the resectedgroup.Conclusion: Our results suggest that in chronic pancreatitisthe type of surgery has to be individualized in each patient(resection VS drainage) and organ preserving operations aresafe and effective in providing long-term pain relief and in treating CP-related complications.

Background: Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment or in the presence of complications of the disease.Aims: This study evaluates a single-center experience with operative management of chronic pancreatitis over a period of time of 14 years, regarding indication, surgical technique, early and late results. Patients and Methods: The records of 265 consecutive patients who underwent surgery for chronic pancreatitis between 1995and 2008 were retrospectively reviewed and analyzed. Long-term outcomes were assessed by the patient survey, with a median follow-up of 40 months. Results: 265 patients underwent 275 operations for chronic pancreatitis with the main indication abdominal pain(46,8%), followed by suspected malignancy in 24,8 % and recurrent episodes of acute pancreatitis in 18,6%. Resection procedures 54,5% (150), drainage procedures 1,09% (3), bypass and denervation procedures 44,36% (122) and exploratory laparotomy 3,27% (9) were performed with an overall morbidity of 22 % and an in-hospital mortality rate of 2,64%. After a median follow-up of 40 months, survival information was available for 137 patients (51,69%) with a corresponding author: the 225-and actuarial survival rate of 74,7% and quality of life-improvement in most patients, especially in the resected group. Conclusion: Our results suggest that in chronic pancreatitis the type of surgery has to be individualized in each patient(resection VS drainage) and organ-preserving operations are safe and effective in providing long-term pain relief and in treating CP-related complications.