Short- and long-term outcomes of surgical management of chronic pancreatitis

Chronic pancreatitis (CP) is a relatively rare disease with annual incidence approximately 10 new cases per 100,000 persons. Patients usually suffer from chronic abdominal pain and/or complications of CP. Present study assessed: 1. Long-term survival, causes of death and impact of risk factors on survival; 2. Prevalence of complications of CP in a surgically treated cohort prior to and following surgical treatment; 3. The impact of surgical method on the occurrence of new complications of CP during follow-up, and through this assessment evaluated advantages and disadvantages of different surgical methods; 4. The possible advantages and disadvantages of short and long pancreatojejunostomy in treatment of CP. The study was based on data of 166 surgically treated patients with CP at Tartu University Hospital. Results: 1. Patients with surgically treated CP had standardized mortality ratio of 1.8, patients resuming moderate/heavy alcohol consumption after surgical treatment of CP had SMR of 2.7. 2. The major risk factors for death were alcohol consumption and smoking; high co-morbidity index; unemployment; and low BMI. 3. Alcohol-related and smoking-related non-pancreatic diseases caused the vast majority of deaths. CP-related mortality was low. 4. Defining common pathophysiological mechanisms, a novel pathophysiological classification of complications of CP is proposed. 5. This classification allows grouping of different complications and making general observations. It also demonstrated pros and cons of different surgical methods in the treatment of CP and revealed the impact of the type of the surgical method on the occurrence of new complications. 6. The presence and pathophysiological nature of complications should be among the main determinants in clinical decision making and in surgical choice. 7. In the treatment of patients with CP and a uniformly dilated pancreatic duct, short pancreatojejunostomy provides as effective pain relief as long anastomosis. While the perioperative characteristics of short anastomosis surpass those of long one, short anastomosis should be the preferred surgical option.