The aim of this study was to analyze the evolution of surgical indications in alcoholic chronic pancreatitis (ACP) and to compare long term results after medical (n = 72) and surgical (n = 150) treatment with or without pancreatic resection. Since 1968, a retrospective study was carried out on 222 consecutive male patient. 68% of them, were operated on for unrelieved pain or complications at a mean of 5 years after the onset of the symptom. The mean follow-up was 10 years. The study of evolution of the indications and results of surgical treatment was made on two consecutive ten-year periods and showed that 68% of pancreaticoduodenectomies and 55% of distal pancreatectomies (DP) were performed during the first period. Indications for primary pancreaticoduodenectomy did not decrease since 1980, while those of distal pancreatectomy (DP) changed (no DP for acute pancreatic effusion with fistula before 1980, no DP for unrelieved pain after 1980). Ten patients underwent operative drainage of pseudocysts before 1980 versus 21 after 1980 (13% vs 29%) with no operative death. Twenty patients underwent biliary and/or intestinal and/or ductal drainage during the first period versus 22 during the second (25% vs 30%). The overall 12-year actuarial survival between operated and non operated patients was no significantly different (respectively 72% +/- 10% and 64% +/- 12%). The actuarial 10-year survival rate was significantly better after DP (73% versus 53% after drainage and 28% after pancreaticoduodenectomy). No patients underwent specific pancreatic reoperation after pancreaticoduodenectomy versus 25% after DP.(ABSTRACT TRUNCATED AT 250 WORDS)