A single-center analysis of surgical treatment for chronic pancreatitis: relatively rare and unevenly deployed

Background: Management of chronic pancreatitis remains a challenge. Current strategies reserve surgery as a last-available option after medical therapy, lifestyle modifications, and endoscopy have failed. Some clinicians advocate early consideration of surgical treatment to prevent disease progression and reduce the risk of opioid dependency. Aims: The aim of this study was to describe the use of elective surgery for chronic pancreatitis in a high-volume, teaching hospital. Patients & methods: Retrospective analysis of administrative patient data for in-patients with chronic pancreatitis 2003 2013 inclusively. Demographic and clinical information, including number of admissions and costs, was obtained through hospital decision support. Surgery of interest: Frey procedure, pancreaticoduodenectomy, total pancreatectomy, distal pancreatectomy, and Duodenum-Preserving Pancreatic Head Resection. Debridements and emergent pancreatic operations excluded. Results: Of 3,480 patients, 406 (11.7%) received surgery of interest. Both newchronicpancreatitisdiagnosesandproceduresperformedremainedstable throughout this time period. Whipple and other pancreaticoduodenectomies comprised the largestproportionofoperationswith48.8% (n1⁄4198). 22.7%were distal pancreatectomy, and 18.7%were pancreatojejunostomy including Frey’s procedure. There was a non-significant decrease in use of pancreaticoduodenectomy over time. The group receiving surgery was older (mean: 57.8 vs. 54.2 years <0.0001), more likely to be male (21.6% vs. 18.3% p1⁄40.017), white (OR: 1.88 95% CI: 1.4-2.5), married (OR 1.4, 95% CI: 1.1-1.7). Conclusion: Only a minority of patients appear to undergo elective pancreas-directed surgery for chronic pancreatitis. There is heterogeneity in receiving resection across demographic groups. Further investigation with patient risk adjustment comparing clinical outcomes of definitive surgery is warranted. Abstracts / Pancreatol S40