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Evidence-Based Surgical Treatments for Chronic Pancreatitis
Jörg Kleeff1, Christian Stöß, Julia Mayerle
1Department of General, Visceral, and Pediatric Surgery, Düsseldorf University Hospital, Düsseldorf; Department of Sur gery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom; and Department of Molecular and Clinical Cancer Medi cine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Department of Internal Medicine A, Faculty of Medicine, University of Greifswald, Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Department of Surgery, University Hospital Erlangen.
Background:
If conservative treatment of chronic pancreatitis is unsuccessful, surgery is an option. The choice of the most suitable surgical method can be difficult, as the indications, advantages, and disadvantages of the available methods have not yet been fully documented with scientific evidence.
Methods:
In April 2015, we carried out a temporally unlimited systematic search for publications on surgery for chronic pancreatitis. The target parameters were morbidity, mortality, pain, endocrine and exocrine insuffi - ciency, weight gain, quality of life, length of hospital stay, and duration of urgery. Differences between surgical methods were studied with network meta-analysis, and duodenum-preserving operations were compared with partial duodenopancreatectomy with standard meta-analysis.
Results:
Among the 326 articles initially identified, 8 randomized controlled trials on a total of 423 patients were included in the meta-analysis. The trials were markedly heterogeneous in some respects. There was no significant difference among surgical methods with respect to perioperative morbidity, pain, endocrine and exocrine insufficiency, or quality of life. Duodenumpreserving procedures, compared to duodenopancreatectomy, were associated with a long-term weight gain that was 3 kg higher (p <0.001; three trials), a mean length of hospital stay that was 3 days shorter (p = 0.009; six trials), and a duration of surgery that was 2 hours shorter (p <0.001; five trials).
Conclusion:
Duodenum-preserving surgery for chronic pancreatitis is superior to partial duodenopancreatectomy in multiple respects. Only limited recommendations can be given, however, on the basis of present data. The question of the best surgical method for the individual patient, in view of the clinical manifestations, anatomy, and diagnostic criteria, remains open.
Insights
For chronic pancreatitis, duodenum-preserving surgery offers advantages over partial duodenopancreatectomy, including better weight gain and shorter hospital stays. However, the optimal surgical choice for individual patients remains unclear.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Chronic pancreatitis management often requires surgical intervention when conservative treatments fail.
- Selecting the optimal surgical approach is challenging due to limited evidence on indications, benefits, and drawbacks.
Purpose of the Study:
- To systematically review and compare surgical methods for chronic pancreatitis.
- To evaluate outcomes including morbidity, mortality, pain, and functional insufficiency.
Main Methods:
- A systematic literature search was conducted in April 2015 for surgical treatments of chronic pancreatitis.
- Network meta-analysis compared various surgical techniques; standard meta-analysis compared duodenum-preserving operations with partial duodenopancreatectomy.
Main Results:
- Eight randomized controlled trials (423 patients) were included in the meta-analysis.
- No significant differences were found in perioperative morbidity, pain, or functional outcomes among surgical methods.
- Duodenum-preserving procedures showed superior long-term weight gain, shorter hospital stays, and reduced surgery duration compared to partial duodenopancreatectomy.
Conclusions:
- Duodenum-preserving surgery demonstrates advantages over partial duodenopancreatectomy for chronic pancreatitis.
- Current data provide limited recommendations for choosing the best surgical method for individual patients.
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