Surgical therapy of chronic pancreatitis: clinical results and health-related quality of life

Christian Benzing; Hans-Michael Hau; Georgi Atanasov; Felix Krenzien; Tim Eisenhauer; Johannes Broschewitz; Michael Bartels; Moritz Schmelzle; Georg Wiltberger

doi:10.1055/a-0713-0873

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2018; 56(11): 1354-1364
DOI: 10.1055/a-0713-0873

Originalarbeit

Surgical therapy of chronic pancreatitis: clinical results and health-related quality of life

Chirurgische Therapie der chronischen Pankreatitis: klinische Resultate und gesundheitsbezogene Lebensqualität

Authors

Christian Benzing

¹Department of Surgery, Campus Virchow and Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
Hans-Michael Hau

²Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
Georgi Atanasov

¹Department of Surgery, Campus Virchow and Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
Felix Krenzien

¹Department of Surgery, Campus Virchow and Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
Tim Eisenhauer

²Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
Johannes Broschewitz

²Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
Michael Bartels

³Department of General- and Visceral surgery, Helios Clinic Leipzig, Germany
Moritz Schmelzle

¹Department of Surgery, Campus Virchow and Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany
Georg Wiltberger

⁴Department of General, Visceral, and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany

Abstract

Introduction There are several well-established surgical procedures for the treatment of chronic pancreatitis (CP). The present study seeks to evaluate the perioperative and long-term outcome of these procedures.

Methods All patients who had undergone pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR), and distal pancreatectomy (DP) for CP were retrospectively analyzed with regards to the perioperative outcome and long-term survival. Health-related quality of life (HRQoL) was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

Results There were 145 patients available for analysis. Major complications (grade IIIb–V) occurred in 19 %, in-hospital mortality was 4.2 %, and 90-day mortality was 3 % with no differences between the different resection groups (all p > 0.05). Ten-year survival was 58 % and was highest in the DP group (100 %) but without statistical significance (p = 0.72). The response rate of the HRQoL assessment was 45 % (65 of 145). There was a significant improvement with regards to pain and HRQoL of all resection groups compared to the preoperative group (all p < 0.05). With respect to HRQoL and pain relief, the PD, DPPHR, and DP did not differ significantly.

Discussion Surgical therapy of CP can be performed safely. The 3 different types of resection performed equally with regards to complications and HRQoL.

Zusammenfassung

Einleitung Es gibt mehrere gut etablierte chirurgische Verfahren zur Behandlung der chronischen Pankreatitis (CP). Das Ziel der vorliegenden Studie ist es, die perioperativen Resultate und klinischen Langzeitergebnisse sowie die Lebensqualität der verschiedenen Operationsverfahren zu evaluieren.

Methoden Alle Patienten, bei denen eine Pankreatikoduodenektomie (PD), eine duodenumerhaltende Pankreaskopfresektion (DPPHR) oder Pankreaslinksresektion (DP) zur Behandlung einer CP durchgeführt wurde, wurden retrospektiv hinsichtlich der perioperativen Ergebnisse und Langzeitüberleben analysiert. Die gesundheitsbezogene Lebensqualität (HRQoL) wurde mithilfe des European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) untersucht.

Ergebnisse Es wurden 145 Patienten analysiert. Schwerwiegende Komplikationen (Grad IIIb-V) traten in 19 % auf, die Krankenhausmortalität lag bei 4,2 % und die 90-Tage-Mortalität bei 3 % ohne Unterschiede zwischen den verschiedenen Resektionsgruppen (alle p > 0,05). Das 10-Jahresüberleben betrug 58 % und war am höchsten in der DP-Gruppe (100 %, p = 0,72). Die Rücklaufquote der HRQoL-Fragebögen betrug 45 % (65 of 145). Postoperativ zeigte sich eine deutliche Verbesserung hinsichtlich Schmerzen und HRQoL in allen postoperativen Gruppen im Vergleich zur präoperativen Gruppe (alle p-Werte < 0,05). In Bezug auf die HRQoL und Schmerzlinderung unterschieden sich die Gruppen PD, DPPHR und DP nicht signifikant.

Diskussion Die chirurgische Therapie der CP kann unabhängig vom Resektionsverfahren sicher durchgeführt werden. Hinsichtlich der HRQoL zeigen sich keine Unterschiede in Abhängigkeit des Verfahrens.

Key words

chronic pancreatitis - surgical therapy - pancreaticoduodenectomy - duodenum-preserving pancreatic head resection - distal pancreatectomy - quality of Life

Schlüsselwörter

chronische Pankreatitis - Lebensqualität - chirurgische Therapie - Pankreasresektion - Pankreatikoduodenektomie - Morbidität

Full Text

References

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