Long-term follow-up of chronic pancreatitis patients who underwent the pylorus-preserving variant of the Whipple resection procedure shows that results are ultimately comparable to those achieved using the more recent Frey organ-sparing extended drainage approach, according to German researchers.
In the May issue of Gastroenterology, Dr. Tim Strate of University Hospital, Hamburg and colleagues report on their follow-up of 60 patients who, in an earlier study, had been randomized to the Whipple or Frey procedure. All had suffered intractable pain at the time of the operation.
Ten patients died during follow-up and 47 were available for study after 7 years. Most causes of death were not related to pancreatitis.
The team found that there were no differences between groups in quality of life, pain control, or other somatic parameters.
In addition, although the earlier study had indicated that the organ-sparing procedure was potentially more beneficial because it better preserved exocrine and endocrine function, no differences were seen in the long term.
The co-author of an accompanying editorial, Dr. Markus W. Buechler of the University of Heidelberg, Germany, told Reuters Health, "Severe chronic pancreatitis can be successfully treated by surgery with good long term results. The more modern procedures — the duodenum preserving procedures — provide better early outcome and comparable late outcome to that with old-fashioned Whipple procedures."
He and Dr. Andrew L. Warshaw of Harvard Medical School, Boston observe that given the similarities in outcome, "At the end of the day, experienced surgeons are justified in choosing the surgical tactic with which they are most comfortable."
Gastroenterology 2008;134:1406-1411.
Reviewed by Ramaz Mitaishvili, MD
