Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis

PURPOSE: To examine whether preoperative computed tomography (CT) scans and pancreatograms can: (1) identify patients with chronic pancreatitis localized to the tail of the pancreas; and (2) select those patients who can obtain pain relief from a distal pancreatectomy. PATIENTS AND METHODS: Twenty patients were identified on whom the authors had performed distal pancreatectomy for relief of pain between January 1, 1991 and August 1, 1994. The results of surgery were classified as good, fair, or poor based on return to work and need for narcotics or rehospitalization. RESULTS: Eleven patients had good, 3 fair, and 6 poor results. All 7 patients with pseudocysts of the tail of the pancreas had good results, while 9 of 13 patients without pseudocysts had poor results. No other finding on CT scan, pancreatography, or laparotomy predicted successful pain relief by distal pancreatectomy. Furthermore, 3 patients had unexpected carcinoma found at the time of surgery. CONCLUSIONS: Even when anatomic evidence suggests that chronic pancreatitis primarily involves the tail of the pancreas and there is a structure of the midpancreatic duct that is believed to cause the symptoms, distal pancreatectomy seldom provides sustained pain relief. Unsuspected carcinoma of the body and tail of the pancreas occurs frequently in this subset of patients with chronic pancreatitis.