The role of surgery in chronic pancreatitis

Frola, C; Somasundaram, Murali; Hariharan, Deepak; Kolaitytė, Valdonė; Mohandas, Shailesh; Stättner, Stefan; Yip, Vincent

doi:10.1007/s10353-019-0591-z

Cited by 7 publications

(5 citation statements)

References 46 publications

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“…Thus, the choice of the surgical procedure should proceed from at least four aspects; predominant indication for surgery; anatomical changes of the pancreatic gland; presence and entity of local complications of CP; and procedure-specific risks of surgery (immediate and long-term). This is consistent with the conclusion by Frola et al [ 80 ] according to which a tailored approach to CP patients is mandatory[ 80 ].…”

Section: Discussionsupporting

confidence: 93%

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Murruste¹,

Kirsimägi²,

Kase³

et al. 2022

WJCC

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BACKGROUND Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification. AIM The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up. METHODS After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP. RESULTS We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency. CONCLUSION The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.

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Section: Discussionsupporting

confidence: 93%

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Murruste¹,

Kirsimägi²,

Kase³

et al. 2022

WJCC

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“…Important mechanisms are (1) the direct effect of toxic metabolites on acinar cells, (2) acute pancreatitis causing activation of pancreatic stellate cells with subsequent fibrosis (two-hit model), (3) formation of protein plugs causing ductal dysfunction leading to obstruction, (4) free radicals promoting fusion of lysosomes causing oxidative stress to acinar cells, and (5) repeated episodes of acute pancreatitis causing a necrosis-fibrosis sequence. [20]…”

Section: Pathogenesismentioning

confidence: 99%

“…In addition, it is better for the patient to undergo surgery within three years of symptoms. [20] Patients with pancreatic head inflammatory masses may experience pain, gastric outflow obstruction, and biliary obstruction. These patients typically benefit from pancreaticoduodenectomy with reconstruction, duodenum-preserving pancreatic head resection, or partial resection of the pancreatic head with pancreaticojejunostomy (Frey's operation).…”

Section: Surgical Managementmentioning

confidence: 99%

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Chronic pancreatitis - an update

Gobishangar

2021

Jaffna Med. J.

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Chronic pancreatitis (CP) is a progressive inflammatory process that causes irreversible damage to the pancreas due to fibrosis and scarring. The incidence of CP varies among regions. Alcohol consumption and smoking are the main aetiological factors of CP. In addition, autoimmune diseases, hereditary and genetic factors, and tropical CP also contribute to this condition. Though no single mechanism has been shown to initiate CP pathogenesis, this disease ultimately results in fibrosis, scarring, and insufficiency in the pancreas. Chronic upper abdominal pain, steatorrhea, malnutrition, and diabetes mellitus are the main clinical features of CP. Detecting this disease at an early stage is difficult unless it is explicitly checked for due to strong suspicions. Nevertheless, pancreatic function tests, imaging, and endoscopy are used to diagnose CP. Pain management, exocrine supplementation, diabetic management, and endoscopic or surgical drainage and resection procedures are essential for managing CP. Early surgical intervention can improve the remaining pancreatic reserve, delay pancreatic failure, and improve the quality of life of patients with this disease.

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“…The experienced Innsbruck group provides a comprehensive overview, highlighting also the necessity of around the clock availability of these services to resolve many of our surgical complications (Putzer et al; [4]). The underestimated but important role of surgeons in treatment of chronic pancreatitis is illuminated by Frola et al from the Royal London Hospital, presenting the current literature and their clinical algorithm on how to deal with these complex patients [5]. Furthermore, the broad and emerging field of cystic pancreatic tumours including precursor lesions is reviewed by the Vienna group (Sahora and Schindl; [6]).…”

mentioning

confidence: 99%