Is Surgery in Autoimmune Pancreatitis Always a Failure?

Area of Science:

• Gastroenterology
• Immunology
• Surgical Pathology

Background:

• Autoimmune pancreatitis (AIP) is a rare chronic pancreatitis subtype with an autoimmune cause.
• Clinical and imaging features of AIP overlap with pancreatic cancer, leading to frequent misdiagnosis.
• Patients may undergo major pancreatic resection for AIP, despite its typical response to corticosteroids.

Purpose of the Study:

• To define the role of surgery in managing autoimmune pancreatitis.
• To review diagnostic criteria and treatment outcomes for AIP.
• To assess the clinical characteristics of AIP patients who underwent pancreatic resection.

Main Methods:

• Review of published case series of AIP diagnosed via histopathology of surgical specimens.
• Assessment of clinical, radiological, and serological details of AIP patients.
• Retrospective review of histopathology from pancreatic resections at the authors' institution over 10 years.

Main Results:

• Autoimmune pancreatitis is frequently misdiagnosed as pancreatic malignancy.
• Pancreatic resection may be required in some cases to exclude malignancy and confirm AIP diagnosis.
• Understanding AIP diagnostic criteria has improved, but surgical intervention remains relevant for definitive diagnosis in select patients.

Conclusions:

• Surgery plays a role in definitively diagnosing autoimmune pancreatitis, particularly when malignancy cannot be excluded.
• Accurate diagnosis is crucial to avoid unnecessary pancreatic resections for AIP, which often responds to medical therapy.
• Further research into non-invasive diagnostic methods for AIP is warranted.