Surgical versus conservative management of groove pancreatitis: a systematic review and meta-analysis

Groove pancreatitis (GP) is a rare form of focal chronic pancreatitis involving the pancreaticoduodenal groove and frequently mimics pancreatic ductal adenocarcinoma, posing significant diagnostic and therapeutic challenges. This review comprehensively evaluated the demographics, clinical presentation, diagnostic approaches, and comparative effectiveness of surgical versus non-surgical management strategies in GP. A total of 24 studies comprising 562 patients were included. The patient-weighted mean age was 50.6 years, with a marked male predominance (84.3%). Abdominal pain (92.3%), weight loss (70.5%), and nausea/vomiting (47.1%) were the most common presenting features. Non-surgical management (conservative and endoscopic approaches) achieved complete success in 78.9% (131/166) of patients, while surgical management achieved complete success in 82.4% (197/239). Random-effects meta-analysis revealed pooled complete success proportions of 0.76 (95% CI 0.56-0.88) for non-surgical treatment and 0.775 (95% CI 0.708-0.830) for surgery. Sensitivity analysis restricted to resective surgical procedures demonstrated a pooled complete success rate of 0.823 (95% CI 0.764-0.870) with no observed heterogeneity (I² = 0.0%). Direct comparative analysis showed no statistically significant difference between strategies (risk ratio 0.99; 95% CI 0.73-1.36), indicating equivalent efficacy. Heterogeneity was substantial in the non-surgical group (I² = 64.2%) but low in the surgical group (I² = 5.8%). Given the observational design, treatment heterogeneity, inadequate follow-up, and indirect nature of most comparisons, the available evidence does not establish superiority or equivalence between surgical and non-surgical management. Non-surgical management may be considered as an initial approach in selected patients, whereas surgery remains appropriate for refractory, complicated, or diagnostically uncertain cases.