A binational analysis of 252 pancreatic resections for chronic pancreatitis with regard to incidental carcinoma sequence and overall postoperative outcome

Abstract

Introduction: Therapeutic treatment algorithms for patients with chronic pancreatitis remain to be debated controversially until today. Especially surgical therapy is often only considered after long-term conservative treatment. The aim of this study was a binational analysis of patients who underwent pancreatic resections for suspected chronic pancreatitis at an austrian and german high-volume center with regard to incidental carcinoma sequence and overall postoperative outcome. Patients and methods: An overall of 252 consecutive pancreatic resections for suspected chronic pancreatitis were performed at both institutions between 2005 and 2015. In a binational retrospective analysis both postoperative results as well as histopathological findings were analyzed. Results: Pancreatic resections were performed in 193 male (76.6%) and 59 female patients (23.4%) with a median age of 53.2 years. A total of 175 pancreatic head resections (69.4%), 37 distal pancreatectomies (14.7%), 23 total pancreatectomies (9.1%) and 18 other pancreatic resections (7.1%) were performed within our study period. Postoperative complications > Clavien II occurred in 94 patients (37.3%). 21 patients (8.3%) developed clinically relevant postoperative pancreatic fistula (grade B and C), while postoperative mortality occurred in 5 patients (2.0%). Final histological examination of the operation specimen revealed an incidental pancreatic adenocarcinoma in 18 out of the 252 patients (7.1%). Conclusion: The results of our study demonstrate that pancreatic resections for chronic pancreatitis may nowadays be considered as technically feasible and safe. Especially the high incidence of incidental pancreatic adenocarcinoma underlines the necessity for an early surgical therapy approach in these patients.