Chronic Pancreatitis Surgical Treatments

Major surgical procedures can effectively treat Chronic pancreatitis (CP), including pylorus-preserving pancreaticoduodenectomy (PPPD), Beger surgery, Frey's revision, and Berne's revision, says an article published in Frontiers in Surgery.

Chronic pancreatitis (CP) is a progressive, irreversible, fibroinflammatory disease characterized by persistent pancreatic parenchymal destruction and fibrosis, leading to intractable pain and decreased quality of life (QOL). As the disease advances, there is a continual loss of pancreatic function and local complications (e.g., ductal obstruction, pancreatic pseudocysts, etc.). Surgery is an effective option for treating chronic pancreatitis. However, there is no clear consensus on the best choice for surgical procedures. Therefore, Yu Mou and his team aimed to conduct a network meta-analysis of randomized controlled trials comparing treatment outcomes to provide high-quality evidence on which surgery is best for CP.

Main Results of the Study

• Ten studies with a total of 680 patients were identified for inclusion.
• PPPD was associated with superior short-term postoperative pain relief and quality of life (QOL), but exacerbated pancreatic exocrine dysfunction and high morbidity.
• Berne's revision had significantly higher long-term postoperative pain relief and mortality, and a lower risk of exocrine pancreatic insufficiency.

In summary, major surgical procedures, including PPPD, Beger's surgery, Frey's revision, and Berne's revision, can effectively treat CP in the short term as well as the long term. Also, Berne's method is simpler than PPPD and Beger's method. However, Berne's modification may reduce postoperative QOL. In our experience, PPPD or classic pancreatoduodenectomy should be the only legitimate option if a CP patient has a mass indistinguishable from pancreatic cancer in the pancreatic head.

Reference

Mou, Y., Song, Y., Chen, H.-Y., Wang, X., Huang, W., Liu, X.-B., & Ke, N.-W. (2022). Which Surgeries Are the Best Choice for Chronic Pancreatitis: A Network Meta-Analysis of Randomized Controlled Trials. In Frontiers in Surgery (Vol. 8). Frontiers Media SA. https://doi.org/10.3389/fsurg.2021.798867