Surgical Approaches to Chronic Pancreatitis

Abstract

Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.

Endoscopic vs. Surgical Interventions for Painful Chronic Pancreatitis: What is Needed for Future Clinical Trials

“… 7 Further research is required to answer a number of questions in regards to endoscopic stenting. 5 Many randomized controlled trials have been performed to determine optimal surgical treatment, 6 although these trials are still beset by problems with patient selection, timing of intervention and assessment of pain. Total pancreatectomy and auto islet transplantation is a promising surgical option that has yet to be widely adopted, and for which further evidence is required regarding its role in relation to other surgical treatments.…”

“…This disagreement appears to derive from entrenched practice and the lack of high-quality evidence. It is not helped by contradictory guideline recommendations 2 , 3 , 4 and opinion, 5 , 6 ostensibly drawn from the same evidence base and used to justify the highly variable practice.…”

A Panel of CA19-9, Ca125, and Ca15-3 as the Enhanced Test for the Differential Diagnosis of the Pancreatic Lesion

“…Moreover, patients treated with Frey procedure had longer mean survival time (14.5 ± 0.8 versus 11.3 ± 0.8 years; p = 0.037). Previously published trials also showed that organ sparing procedures such as Frey or Beger procedures yield better outcome than more aggressive treatment with PD [ 13 ]. Thus, not only should the ideal biomarker of PDAC be detectable on the early stage of carcinogenesis, but also it should be highly accurate as patients with benign lesions greatly benefit from organ sparing surgical techniques.…”

MiR‐375 and miR‐200c as predictive biomarkers of islet isolation and transplantation in total pancreatectomy with islet autotransplantation

“…Chronic pancreatitis (CP) is an irreversible and progressive pancreatic disease caused by inflammation of the exocrine tissue . CP leads to persistent abdominal or back pain, malnutrition, and even diabetes with sufficient islet damage.…”