Outcomes after Frey's procedure for chronic pancreatitis: A 8-year single-center experience in Colombia

Abstract

Background Chronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of Colombia's population undergoing Frey's surgery for chronic pancreatitis in a high complexity center experience treating this disease. Methods A retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a high complexity center in Bogotá, Colombia, was made. A demographic, clinical and postoperative outcome description was performed. Logistic regression and t-test analysis was performed when appropriate between operative variables and long-term outcomes. Results Eighteen patients met the inclusion criteria. 55.5 % of patients were male. Chronic pancreatitis etiology in most cases (83.3% n=15) was idiopathic. The mean duration of symptoms and chronic pancreatitis diagnosis before surgery was 18.6 ± 26.9 months. Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The mean pain reduction was 3.3 ± 1.02 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). A protective exposure is present in patients with duct diameter < 6 mm. (OR 0.6 CI 95% 0-0.9).ConclusionAccording to our data, Frey's procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size < 6 mm at the moment of the procedure was related to a lesser risk of pancreatic cancer; however, further prospective studies with a larger sample size would be helpful to confirm these results.