ID: 424 (Conflict of Interest: K)

Die duodenum-erhaltende Pankreaskopfresektion ist der partiellen Pankreatoduodenektomie in der Behandlung der chronischen Pankreatitis nicht überlegen: Ergebnisse einer multizentrischen, randomisiert, kontrollierten Studie

M. K.Diener, F. J.Hüttner, M. W.Büchler, C.Trial Group
Universitätsklinikum Heidelberg, Heidelberg


Surgery has been shown to be superior to medical treatment for chronic pancreatitis but the optimal surgical treatment option remains unclear. Smaller randomized controlled trials showed superiority in short-term outcomes for duodenum-preserving pancreatic head resection (DPPHR) compared to partial pancreatoduodenectomy (pPD).

Material und Methoden

A patient and observer blinded, randomized, controlled superiority trial allocating patients planned for elective surgery due to chronic pancreatitis to either DPPHR or pPD was conducted in 18 European centers. In a pragmatic approach, all modifications of DPPHR (Beger, Frey, Berne) and pPD (pylorus-preserving or classical Whipple’s procedure) were legitimate within the randomized groups. The primary endpoint was mean quality of life (QoL) within two years after surgery assessed by the ‘physical functioning’ scale of the EORTC QLQ-C30 questionnaire. Secondary endpoints included other QoL scales, mortality, morbidity, postoperative pancreatic function (endocrine/exocrine), length of hospital stay, readmissions and reoperations due to chronic pancreatitis.


Over a period of four years, 250 patients were randomized to either DPPHR (n=125) or pPD (n=125). 115 patients in the DPPHR group and 111 patients in the pPD group were finally analyzed in the modified intention-to-treat analysis. Mean QoL within two years after surgery showed no significant difference between the two groups (DPPHR 73.0 ± 16.4; pPD 75.3 ± 16.4). Several QoL and pain scales of the EORTC QLQ-C30 and PAN26 showed significant postoperative improvement in both groups. While mortality, morbidity and other secondary endpoints did not differ between the groups, DPPHR showed a significantly higher rate of rehospitalization due to chronic pancreatitis compared to pPD.


Results from single-centre trials demonstrating superiority of DPPHR over pPD in the treatment of chronic pancreatitis were not confirmed in the multicenter setting. DPPHR and pPD showed no difference in QoL, mortality and morbidity after surgery for chronic pancreatitis. However, pPD seems to represent the more definitive treatment, as shown by the lower rate of rehospitalisation.