Chronic pancreatitis: how does surgery step in?

Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas characterized by irreversible morphological changes that lead to chronic abdominal pain, exocrine and endocrine insufficiency, and a significant reduction in quality of life. Historically, surgical intervention was considered a last-line option, reserved for patients in whom conservative or minimally invasive therapies had failed. However, growing evidence suggests that early surgical management may provide superior outcomes in terms of pain control and quality of life. The surgical management of CP encompasses a spectrum of procedures tailored to disease morphology and symptom profile. These include drainage procedures for patients with a dilated pancreatic duct, formal pancreatic resections for localized inflammatory masses or in cases with a high suspicion of malignancy, and combined resection-drainage techniques when ductal dilatation coexists with an inflammatory mass in the pancreatic head. A multidisciplinary evaluation is recommended for all patients prior to intervention to ensure optimal patient selection and individualized treatment planning. This review provides a narrative synthesis of the current literature on surgical indications, timing, techniques, postoperative outcomes, and long-term results, offering a comprehensive overview of contemporary evidence and clinical decision-making in the surgical management of CP.