Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7808-7824
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7808
Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification
Marko Murruste, Ülle Kirsimägi, Karri Kase, Tatjana Veršinina, Peep Talving, Urmas Lepner
Marko Murruste, Ülle Kirsimägi, Karri Kase, Tatjana Veršinina, Urmas Lepner, Department of Surgery, Tartu University Hospital, Tartu 50406, Estonia
Peep Talving, Department of Surgery, Board, North Estonia Medical Centre, Tallinn 13419, Estonia
Author contributions: Murruste M, Kirsimägi Ü, Kase K, Veršinina T, Talving P, and Lepner U designed the study; Murruste M, Kirsimägi Ü, Kase K, and Veršinina T performed the study; Murruste M and Kirsimägi Ü produced the statistics and wrote the paper.
Institutional review board statement: The study was reviewed and approved by the University of Tartu (UT REC) Institutional Review Board, No. 291/T-1.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marko Murruste, MD, Doctor, Surgeon, Department of Surgery, Tartu University Hospital, 8 Puusepa Str, Tartu 50406, Estonia. marko.murruste@kliinikum.ee
Received: January 3, 2022
Peer-review started: January 4, 2022
First decision: March 12, 2022
Revised: March 22, 2022
Accepted: June 13, 2022
Article in press: June 13, 2022
Published online: August 6, 2022
Processing time: 199 Days and 11.9 Hours
ARTICLE HIGHLIGHTS
Research background

Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there exists so far no comprehensive pathophysiological classification.

Research motivation

The motivation of present study was: To propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up.

Research objectives

To describe the full diversity of severe complications of CP seen in our cohort during 20 years of study using proposed classification of complications of CP; and to assess the impact of surgical treatment on the development of new complications during follow-up.

Research methods

After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of the complications of CP was evaluated, according to the proposed classification, in a surgical cohort of 166 patients.

Research results

We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3% and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, 15 years following surgery.

Research conclusions

The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of the complications of CP and the risk of development of new ones should be among main determinants of surgical choice.

Research perspectives

It would be interesting to compare the effectiveness of the surgical and endoscopic treatment of complications of CP using our proposed classification.