Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines

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Publication Details

Journal
Annals of Surgery
Published
2026-09-04
DOI
https://doi.org/10.1097/sla.0000000000007202
Primary Topic
Pancreatitis Pathology and Treatment
Type
article
Field-Weighted Citation Impact
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article

Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines

Janis Pavulans, Robert C. Verdonk, Fabio Ausania, Lancelot Marique et al.
Annals of Surgery
Pancreatitis Pathology and Treatment
article

Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines

Janis Pavulans, Robert C. Verdonk, Fabio Ausania, Lancelot Marique, Christina Krikke, Charlotte L. van Veldhuisen, Arturan İbrahimli, Filip Gryspeerdt, C. Leseman, Kevin C. Conlon, Roel Haen, Anne Waage, Tore Tholfsen, Pasquale Scognamiglio, JSD Mieog, Jakob R. Izbicki, Fleur E.M. De Rijk, Susan van Dieren, Marie Toschka, Marja Boermeester, Faik G. Uzunoglu, Gennaro Nappo, Orlin Belyaev, Rogier P. Voermans, Frederik Berrevoet, Hjalmar C. Van Santvoort, Arto Kokkola, Safi Dokmak, Geert Roeyen, Olivier R. Busch, Joana C. Marques-Antunes, Stefan A. Bouwense, Haralds Plaudis, Massimo Falconi, Casper H.J. Van Eijck, Ugo Boggi, Jeanin E. van Hooft, Domenico Tamburrino, Marc G. Besselink, Poya Ghorbani, Marco J. Bruno
article en

Abstract

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.

Annals of Surgery
University of Pisa (IT), Oslo University Hospital (NO), University Medical Center Groningen (NL), Karolinska University Hospital (SE), University of Helsinki (FI), Humanitas University (IT), Vita-Salute San Raffaele University (IT), Inserm (FR), Universität Hamburg (DE), University of Groningen (NL), Azerbaijan Medical University (AZ), Université Paris Cité (FR), Trinity College Dublin (IE), Hôpital Beaujon (FR), Leiden University Medical Center (NL), Helsinki University Hospital (FI), Ghent University Hospital (BE), Erasmus MC (NL), Tallaght University Hospital (IE), University Medical Center Utrecht (NL), Maastricht University (NL), Assistance Publique – Hôpitaux de Paris (FR), Riga East University Hospital (LV), Antwerp University Hospital (BE), St. Antonius Ziekenhuis (NL), Centre de Recherche sur l'Inflammation (FR), St. Josef-Hospital (DE), Instituto de Investigación Sanitaria de Santiago (ES), Hospital de Santa Maria (PT), Erasmus MC Cancer Institute (NL), Amsterdam University Medical Centers (NL), University of Amsterdam (NL), Ruhr University Bochum (DE)
Good health and well-being
Openalex Percentile: Top 8%
Pancreatitis Pathology and Treatment
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