Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Table 1 Characteristics of the surgically treated patients with chronic pancreatitis

Characteristic	Patients, n = 166
Age in yr	49.8 ± 9.9
Duration of CP before surgery, median (IQR)	1.5 (0.5–3.0)
Male sex, n (%)	140 (84.3)
Etiology of CP, n (%)
Alcoholic	148 (89.2)
Other	18 (10.8)
Predominant indication for surgery, n (%)
Chronic pain	112 (67.5)
Complications of CP1	54 (32.5)
Follow-up (yr), median (IQR)	7.2 (3.8–10.8)
Long-term survival (Kaplan-Meier), (95%CI)
1 yr	100
5 yr	88.2 (83.0–93.5)
10 yr	70.4 (61.7–79.1)
15 yr	41.2 (27.4–55.1)
Median survival in yr	13.9

¹In many cases, patients had also more or less intense abdominal pain.

Data are presented as mean ± SD, unless otherwise specified. CI: Confidence interval; CP: Chronic pancreatitis; IQR: Interquartile range; SD: Standard deviation.

Table 2 Surgical treatment of 166 patients with chronic pancreatitis

Type of surgery	n (%)
Pancreatic resection	60 (36.2)
Pancreatoduodenal resection (Whipple procedure)		11
DPPHR (Beger or Berne or Frey procedure)		34
Pancreatic distal resection		15
Pancreatic drainage operation	93 (56.0)
Pancreaticojejunostomy (Partington-Rochelle)		93
Palliative procedures	13 (7.8)
Biliodigestive anastomosis		11
Gastrointestinal anastomosis		2

DPPHR: Duodenum-preserving pancreatic head resection.

Table 3 Baseline and 15-yr Kaplan-Meier prevalence of complications of chronic pancreatitis in a surgically treated cohort of 166 patients

Complications	Baseline, n (%)		15-yr, Kaplan-Meier, %
Pancreatic duct complications	34	20.5	21.2
Pancreatic pseudocysts	18	10.8
Pancreatic fistulas	16	9.6
Pancreaticoperitoneal (pancreatic ascites)	4	2.4
Pancreaticopleural (pancreatic pleural effusion)	5	3.0
Other (mostly pancreaticocutaneous)	6	4.2
Peripancreatic complications	391	23.5	35.6
Bile duct obstruction	29	17.5
Duodenal obstruction	8	4.8
Venous thrombosis (splenic or portal vein)	5	3.0
Pancreatic hemorrhages	17	10.2	10.2
Contained pseudoaneurysms	7	4.2
Ruptured pseudoaneurysms into	10	6.0
Abdominal cavity	2	1.2
Gastrointestinal tract	6	3.6
Pancreatic duct	2	1.2
Pancreatic exocrine insufficiency–PEI	52	31.3	66.4
Pancreatic endocrine insufficiency–T3cDM	45	27.1	47.1

¹Three patients had two concurrent complications at baseline.

PEI: Pancreatic exocrine insufficiency; T3cDM: Type 3c diabetes mellitus.

Table 4 Distribution of complications of chronic pancreatitis according to the used type of surgical procedure prior to surgical treatment, and appearance of new complications during follow-up, in 166 surgically treated patients

Classification	Type of surgical procedure, n (%)
	PD resection, n = 11	DPPHR, n = 34	Distal resection, n = 15	Drainage procedure, n = 93	Palliative procedures, n = 13	Total, n = 166
Complications, n (%)
Pancreatic duct complications	1 (9.1)	1 (2.9)	4 (26.7)	29 (31.2)	-	35 (21.1)
Preoperative cases	1	1	4	28	-	34
New cases, FU	-	-	-	1	-	1
Peripancreatic complications	6 (54.5)	9 (26.5)	-	25 (26.9)	13 (100)1	55 (33.1)
Preoperative cases	6	4	-	17	13	42
New cases, FU	-	5	-	8	-	13
Pancreatic hemorrhages	1 (9.1)	1 (2.9)	9 (60.0)	6 (6.5)	-	17 (10.2)
Preoperative cases	1	1	9	6	-	17
New cases, FU	-	-	-	-	-	-
PEI	8 (72.7)	15 (44.1)	5 (33.3)	46 (49.5)	9 (69.2)	83 (50.0)
Preoperative cases	1	6	3	33	9	52
New cases, FU	7	9	2	13	-	31
T3cDM	3 (27.3)	12 (35.3)	8 (53.3)	39 (41.9)	11 (84.6)	73 (44.0)
Preoperative cases	1	7	2	25	10	45
New cases, FU	2	5	6	14	1	28

¹Three patients had simultaneously two peripancreatic complications. DPPHR: Duodenum-preserving pancreatic head resection; FU: Follow up; PD: Pancreatoduodenal resection; P: Pancreatic; PEI: Pancreatic exocrine insufficiency; T3cDM: Type 3c diabetes mellitus.