Surgery for chronic pancreatitis: the comparison of two high-volume centers reveals lack of a uniform operative management

Niccolò Surci,Claudio Bassi,Klaus Sahora,Giovanni Marchegiani,Jakob Mühlbacher,Dietmar Tamandl,Luca Casetti,Martin Schindl,Roberto Salvia,Giacomo Deiro,Christina Bergmann

doi:10.1007/s00423-021-02335-1

Abstract

PurposeMany aspects of surgical therapy for chronic pancreatitis (CP), including the correct indication and timing, as well as the most appropriate operative techniques, are still a matter of debate in the surgical community and vary widely across different centers. The aim of the present study was to uncover and analyze these differences by comparing the experiences of two specialized surgical units in Italy and Austria.MethodsAll patients operated for CP between 2000 and 2018 at the two centers involved were included in this retrospective analysis. Data regarding the clinical history and the pre- and perioperative surgical course were analyzed and compared between the two institutions.ResultsOur analysis showed a progressive decrease in the annual rate of pancreatic surgical procedures performed for CP in Verona (no. = 91) over the last two decades (from 3% to less than 1%); by contrast, this percentage increased from 3 to 9% in Vienna (no. = 77) during the same time frame. Considerable differences were also detected with regard to the timing of surgery from the first diagnosis of CP — 4 years (IQR 5.5) in the Austrian series vs two (IQR 4.0) in the Italian series -, and of indications for surgery, with a 12% higher prevalence of groove pancreatitis among patients in the Verona cohort.ConclusionThe comparison of the surgical attitude towards CP between two surgical centers proved that a consistent approach to this pathology still is lacking. The identification of common guidelines and labels of surgical eligibility is advisable in order to avoid interinstitutional treatment disparities.

Highlights

Chronic pancreatitis (CP) is an inflammatory condition leading to permanent structural damage of the pancreatic gland, with variable grades of impairment of its endocrine and exocrine functions [1]
The aim of the present study is to describe, critically review, and compare the twenty years of experience with the surgical treatment of CP at two specialized surgical units in Italy and Austria
The analyzed data showed a considerable progressive decrease in the annual rate of pancreatic surgical procedures for CP during the 2000–2018 period at the Department of General and Pancreatic Surgery of Verona; by contrast, the percentage of surgeries for CP performed at the Vienna General Hospital increased from 3 to 9% during the same time frame (Fig. 3)

Summary

Introduction

Chronic pancreatitis (CP) is an inflammatory condition leading to permanent structural damage of the pancreatic gland, with variable grades of impairment of its endocrine and exocrine functions [1]. The management of this pathology is challenging due to its multiple causes, natural history, impact on patients’ life, and potential complications [2]. A growing number of increasingly complex and diverse surgical operations for the treatment of this disease were reported, until the description of the Puestow (1958) and the Partington-Rochelle (1960) drainage procedures, which represented two milestones in the history of surgery for CP [5, 6]. Operative procedures for chronic pancreatitis are currently grouped into decompression procedures (e.g., Puestow, Partington-Rochelle, Frey, and Beger techniques)

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