Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Creative pancreatectomy provides durable therapy for chronic pancreatitis.
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Thyen Andrew J, Lewellen Kyle A, Lark Meghan E, Maatman Thomas K, House Michael G, Nakeeb Attila, Zyromski Nicholas J
Аннотация
BACKGROUND: Surgical selection for chronic pancreatitis (CP) is based on anatomy. Common approaches include pancreatoduodenectomy (PD), duodenum-preserving pancreas head resection (DPPHR), total pancreatectomy, and distal pancreatectomy. Some patients with complex pancreatic ductal anatomy benefit from non-standard, “creative” pancreatectomy, though little literature exists beyond case reports. We hypothesized that patients undergoing creative pancreatectomy would have good perioperative outcomes and durable results. We therefore evaluated perioperative morbidity and mortality and long-term reintervention rates in a relatively large series of patients with creative pancreatectomy.
METHODS: Among 653 patients undergoing operation for CP between 2007–2023 at a single institution, two variants of creative pancreatectomy were identified: 1) pancreatoduodenectomy with lateral pancreaticojejunostomy (PD+LPJ) and 2) duodenum-preserving pancreatic head resection combined with distal pancreatectomy (DPPHR+DP). Outcome variables were defined according to the American College of Surgeons National Surgical Quality Improvement Project and the International Study Group for Pancreatic Surgery. Major morbidity was defined as Clavien-Dindo grade >II. Descriptive statistics were applied; p<0.05 was considered significant.
RESULTS: Fifteen patients (60% female) had creative pancreatectomy: 7 PD+LPJ and 8 DPPHR+DP (6 with spleen preservation). Preoperative tobacco use was common (53%). Patients in the PD+LPJ group were older (mean ± SD, 58.5±9 vs. 46.5±11 years, p=0.037) and experienced higher intraoperative blood loss (median [IQR], 300[250] vs. 50[200] mL, p=0.029). Clinically relevant pancreatic fistula occurred in 7%. Major morbidity occurred in 3 (20%) patients, all in the DPPHR+DP patient group. No mortality occurred at 90 days postoperatively. At follow-up (median 42.7 months), 3 patients (20%) had undergone pancreas-specific endoscopic or operative therapy: one celiac plexus block and two completion pancreatectomy (one with islet cell autotransplant).
CONCLUSION: Select patients with complex chronic pancreatitis benefit from creative pancreatectomy, which offers durable results and acceptable perioperative morbidity.
METHODS: Among 653 patients undergoing operation for CP between 2007–2023 at a single institution, two variants of creative pancreatectomy were identified: 1) pancreatoduodenectomy with lateral pancreaticojejunostomy (PD+LPJ) and 2) duodenum-preserving pancreatic head resection combined with distal pancreatectomy (DPPHR+DP). Outcome variables were defined according to the American College of Surgeons National Surgical Quality Improvement Project and the International Study Group for Pancreatic Surgery. Major morbidity was defined as Clavien-Dindo grade >II. Descriptive statistics were applied; p<0.05 was considered significant.
RESULTS: Fifteen patients (60% female) had creative pancreatectomy: 7 PD+LPJ and 8 DPPHR+DP (6 with spleen preservation). Preoperative tobacco use was common (53%). Patients in the PD+LPJ group were older (mean ± SD, 58.5±9 vs. 46.5±11 years, p=0.037) and experienced higher intraoperative blood loss (median [IQR], 300[250] vs. 50[200] mL, p=0.029). Clinically relevant pancreatic fistula occurred in 7%. Major morbidity occurred in 3 (20%) patients, all in the DPPHR+DP patient group. No mortality occurred at 90 days postoperatively. At follow-up (median 42.7 months), 3 patients (20%) had undergone pancreas-specific endoscopic or operative therapy: one celiac plexus block and two completion pancreatectomy (one with islet cell autotransplant).
CONCLUSION: Select patients with complex chronic pancreatitis benefit from creative pancreatectomy, which offers durable results and acceptable perioperative morbidity.