• Charlotte L Van Veldhuisen, Charlotte A Leseman, Fleur E M De Rijk, E Nicole Dekker, Martine J Wellens, Nynke Michiels, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen., Christina Krikke, H Sijbrand Hofker, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Centre, Leiden., Stefan A Bouwense, Casper H Van Eijck, Bas Groot Koerkamp, Roel Haen, Marja A Boermeester, Olivier R Busch, Hjalmar C Van Santvoort, Marc G Besselink, and Dutch Pancreatitis Study Group.
• Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam.
• Ann. Surg. 2023 Dec 13.

ObjectiveTo determine the nationwide use and outcome of tailored surgical treatment for symptomatic chronic pancreatitis (CP) as advised by recent guidelines.Summary Background DataRandomized trials have shown that surgery is superior to endoscopy in patients with symptomatic CP, although endoscopy remains popular Recent guidelines advice to "tailor surgery" based on pancreatic morphology meaning that the least extensive procedure should be selected based on pancreatic morphology. However, nationwide, and multicenter studies On tailored surgery for symptomatic CP are lacking.MethodsNationwide multicenter retrospective analysis of consecutive patients undergoing surgical treatment for symptomatic CP in all seven Dutch university medical centers (2010-2020). Outcomes included volume trend, major complications, 90-day mortality, postoperative opioid use and clinically relevant pain relief. Surgical treatment was tailored based on the size of the main pancreatic duct and pancreatic head (e.g. surgical drainage for a dilated pancreatic duct, and normal size pancreatic head).ResultsOverall, 381 patients underwent surgery for CP: 127 surgical drainage procedures ( 33%; mostly extended lateral pancreaticojejunostomy), 129 duodenum-preserving pancreatic head resections (DPPHR, 34%, mostly Frey), and 125 formal pancreatic resections (33%, mostly distal pancreatectomy). The annual surgical volume increased slightly (Pearson r=0.744). Mortality (90-day) occurred in 6 patients (2%), and was non-significantly lower after surgical drainage (0%, 3%, 2%; P =0.139). Major complications (12%, 24%, 26%; P =0.012), postoperative pancreatic fistula grade B/C (0%, 3%, 22%; P =0.038), surgical reintervention (4%, 16%, 12%; P =0.006), and endocrine insufficiency ( 14%, 21%, 43%; P <0.001) occurred less often after surgical drainage. After a median follow-up of 11 months [IQR 3-23] good rates of clinically relevant pain relief ( 83%, 69%, 80%; P =0.082) were observed and 81% of opioid users had stopped using (83%, 78%, 84%, P =0.496).ConclusionThe use of surgery for symptomatic CP increased over the study period. Drainage procedures were associated with the best safety profile and excellent functional outcome, highlighting the importance of tailoring surgery based on pancreatic morphology.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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