Document Detail

Chronic pancreatitis complicated by cavernous transformation of the portal vein: Contraindication to surgery?
MedLine Citation:
PMID:  20684965     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: A subgroup of patients with chronic pancreatitis and severe incapacitating pain develop mesentericoportal vascular complications with extrahepatic portal hypertension (EPH) and subsequent cavernous transformation. The purpose of this study was to address the question of whether a noninterventional approach regarding surgery is justified.
METHODS: A total of 702 patients with chronic pancreatitis underwent major pancreatic surgery. EPH with cavernous transformation was diagnosed in 21 (3%; group C) and EPH without cavernous transformation in 60 (9%; group B). The remaining 621 patients (88%; group A) showed no evidence for extrahepatic hypertension or cavernous transformation. Prospectively collected data were analyzed with respect to perioperative parameters, outcomes, quality of life, and our previously established pain score.
RESULTS: Patients in groups C and B had longer history and greater severity of pain (P = .0001). Group C had the longest operative times (P > .05) and greatest requirements of intraoperatively transfused packed red blood cells (P < .05). Morbidity was greater in group C compared with groups B and A (88% vs 55% vs 35%; P < .001). Mortality was 10% (2/21) in group C, compared with 1.3% (8/621) in group A and 0% in group B (P = .008). Quality of life as well as pain scores significantly improved postoperatively in group C, and were comparable to those in groups A and B (P < .001).
CONCLUSION: Concomitant cavernous transformation in patients with chronic pancreatitis increases the operative risk significantly. Alternative treatment modalities should be evaluated thoroughly in every individual patient to offer every patient the best available treatment. Nevertheless, operative intervention is often the only treatment possible and improvements in quality of life and pain alleviation justify operative interventions.
Maximilian Bockhorn; Florian Gebauer; Dean Bogoevski; Ernesto Molmenti; Guellue Cataldegirmen; Yogesh K Vashist; Emre F Yekebas; Jakob R Izbicki; Oliver Mann
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Publication Detail:
Type:  Journal Article     Date:  2010-08-04
Journal Detail:
Title:  Surgery     Volume:  149     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  321-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Mosby, Inc. All rights reserved.
Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany.
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