Contemporary Outcomes of Pancreatic Head Resection for Chronic Pancreatitis.

Objective: To evaluate perioperative morbidity and mortality outcomes in a large, contemporary series of patients undergoing pancreas head resection for chronic pancreatitis.

Background: Select chronic pancreatitis (CP) patients benefit from pancreatic head resection, but contemporary data are sparse. Anatomy dictates selection of duodenum-preserving pancreatic head resection (DPPHR) or pancreatoduodenectomy (PD). We hypothesized that both DPPHR and PD are safe in select patients.

Methods: CP patients undergoing pancreas head resection from 2007-2023 at a high-volume institution were analyzed. Patient comorbidities, operative data, and postoperative 30-day outcomes were defined according to National Surgical Quality Improvement Program (NSQIP) and International Study Group on Pancreatic Surgery (ISGPS). Preoperative and intraoperative variables between groups were compared. Continuous data are presented as median [interquartile range].

Results: Among 338 patients (50% female), 252 underwent PD and 86 DPPHR (69 Frey, 11 Beger, 4 Izbicki, 2 Bern). Median age was 52[17] years (PD 53.1[17], DPPHR 50.1[20], P=0.036). Preoperative tobacco use (57%) and diabetes (27%) were common. The PD group had longer operative times (282[131] vs. 207.5[91] minutes, P<0.001) and higher intraoperative blood loss (307.5[400] vs. 100[200] milliliters, P<0.001). Median length of stay was 8[6] days (PD 8[6.3], DPPHR 7[4]). Major morbidity occurred in 22% of patients (PD 23%, DPPHR 21%). At 30 days, the readmission rate was 17% (PD 17%, DPPHR 17%) and mortality occurred in 1.2% (PD 1.6%, DPPHR 0%).

Conclusions: This large, contemporary analysis demonstrated safety of pancreatic head resection in select CP patients.