Charlotte L Van Veldhuisen, Charlotte A Leseman, Fleur E M De Rijk, Joana C Marques-Antunes, Fabio Ausania, Orlin Belyaev, Frederik Berrevoet, Marja Boermeester, Ugo Boggi, Stefan A Bouwense, Marco J Bruno, Olivier R Busch, Kevin C Conlon, Safi Dokmak, Massimo Falconi, Poya Ghorbani, Filip Gryspeerdt, Roel Haen, Arturan Ibrahimli, Jakob R Izbicki, Christina Krikke, Arto Kokkola, Lancelot Marique, J S D Mieog, Gennaro Nappo, Janis Pavulans, Haralds Plaudis, Geert Roeyen, Pasquale Scognamiglio, Domenico Tamburrino, Tore Tholfsen, Marie Toschka, Faik G Uzunoglu, Susan Van Dieren, Casper H J Van Eijck, Jeanin E van Hooft, Hjalmar C Van Santvoort, Robert C Verdonk, Rogier P Voermans, Anne Waage, Marc G Besselink, Dutch Pancreatitis Study Group (DSPG) and the Scientific and Research Committee of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA)
The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.
OBJECTIVE: To evaluate the use and impact of current surgical guidelines for chronic pancreatitis (CP) across Europe.
SUMMARY BACKGROUND DATA: Current guidelines recommend morphology-based surgery for CP, but international studies evaluating their use and impact are lacking.
METHODS: Post hoc analysis of the prospective multicenter ESCOPA study, including patients undergoing surgery for symptomatic CP at 22 centers in 13 countries (June 2021-November 2022), with 6-month follow-up. Patients were stratified by morphologic subtype: "isolated dilated main pancreatic duct (MPD)," "isolated enlarged pancreatic head (PH)," "combined dilated MPD and enlarged PH," and "small duct disease." Treatment was based on the European HaPanEU and International IAP-APA-JPS-EPC guidelines. Primary outcomes were 90-day major morbidity, mortality, and pain relief at 6 months. Practice variation was assessed, including a case-based survey.
RESULTS: Overall, 207 patients were included following surgery for CP, with 1.4% 90-day mortality and 72.6% pain relief. The surgical approach varied widely by morphologic subtype: duodenum-preserving pancreatic head resections (DPPHR) were most common for "combined dilated MPD and enlarged PH" (46.8%, P=0.016); whereas formal pancreatectomy predominated for "isolated dilated MPD" (63.3%, P=0.040) and "small duct disease" (66.0%, P=0.004). Guideline-concordant surgery (66%) was not associated with improved rates of major morbidity (12.9% vs. 18.8%, P=0.387), mortality (1.6% vs. 1.6%, P>0.999), or pain relief (75.3% vs. 66.7%, P=0.468). Outcomes were also comparable between drainage/parenchyma-preserving surgery and formal pancreatectomy. Survey findings confirmed practice variation, including the use of formal and V-shaped pancreatectomy for small duct disease.
CONCLUSION: The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.