Modern aspects of diagnosis, prevention and treatment of complications after resection and drainage operations on the pancreas in chronic pancreatitis
https://doi.org/10.65249/1027-7218-2025-12-39-52
Abstract
Based on current literature, this article analyzes data on the diagnosis of chronic pancreatitis, as well as the treatment and prevention of postoperative complications following pancreatic resection and drainage procedures. Despite advances in the surgical treatment of chronic pancreatitis, early and late postoperative complications persist, often leading to repeat surgeries. Currently, there is no gold standard for diagnosing chronic pancreatitis, but the use of non-invasive and minimally invasive techniques remains a top priority. The development of new methods for the early non-invasive diagnosis of chronic pancreatitis, as well as methods for predicting and reducing postoperative complications after pancreatic resection and drainage surgeries and their treatment options, is becoming increasingly important.
About the Authors
A. GlyzdouБеларусь
Yu. Arlouski
Беларусь
References
1. Gal'perin E.I., Semenenko I.A. Fibrosis of pancreas in chronic pancreatitis. Hirurgija. 2015; 12: 96–102. (in Russian)
2. Maev I.V., Kucheryavyj Yu.A., Andreev D.N., et al. Chronic pancreatitis: new approachest o diagnosis and therapy. Moscow: FKUZ “GKG MVD Rossii”; 2014. 32. (in Russian)
3. Ivashkin V.T., Kriger A.G., Okhlobystin A.V., et al. Clinical Guidelines of the Russian Society of Surgeons. Rossijskij zhurnal gastroenterologii, gepatologii, koloproktologii. 2022; 32(2): 99–156. (in Russian)
4. Yadav D., Gawes R.H., Brand R.E., et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med, 2009; 169: 1035–1045.
5. Whitcomb D.C. Pancreatitis: TIGAR-O version 2 risk/etiology checklist with topic reviews, updates, and use primers. Clin Transl Gastroenterol. 2019; 10(6). doi: 10.14309/ctg.0000000000000027.
6. Bishop M.D., Freedman S.D., Zielenski J., et al. The cystic fibrosis transmembrane conductance regulator gene and ion channel function in patients with idiopathic pancreatitis. Hum Genet. 2005; 118: 372–381.
7. Fjeld K., Weiss F.U., Lasher D., et al. A recombinedallele of the lipase gene CEL and its pseudogene CELP confers susceptibility to chronic pancreatitis. Nat Genet. 2015; 47(5): 518–522.
8. Sankaran S.J., Xiao A.Y., Wu L.M., et al. Frequency of progression from acute to chronic pancreatitis and risk factors. Gastroenterology. 2015; 149(6): 490–500.
9. Gardner T.B., Adler D.G., Forsmark C.E. et al. ACG Clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020; 115(3): 322–339.
10. Shevchenko B.F., Babiy A.M., Gravirovskaya N.G., et al. The validity of radiological methods in assessment of inflammatory activity and fibrous transformation of the pancreas at chronic pancreatitis. Novosti hirurgii. 2016; 24(3): 240–248. (in Russian)
11. Phoebe P. Pancreatic stellate cells and fibrosis. Pancreatic cancer and tumor microenvironment. Trivandrum (India); 2012; 3: 29–53.
12. Detlefsen S. Development, immunohistochemical analysis and diagnostic criteria of fibrosis in the normal pancreas, alcoholic chronic pancreatitis and autoimmune pancreatitis. Denmark; 2008. 62.
13. Ahmedov V.A., Gaus O.V. New aspects of the formation and progression of pancreatic fibrosis in pancreatitis. Vestnik kluba pankreatologov. 2019; Maj: 20–23. (in Russian)
14. Grigor’eva I.N. Matrix metalloproteinases in pancreatic diseases. Gastrojenterologija. 2010; 1: 21–24. (in Russian)
15. Sarles H., Bernard J.P., Gullo L. Pathogenesis of chronic pancreatitis. Gut. 1990; 31(6): 629–632.
16. Noronha M., Bordalo O., Dreiling D.A. Alcohol and the pancreas. II. Pancreatic morphology of advanced alcoholic pancreatitis. Am J Gastroenterol. 1981; 2: 120–124.
17. Palkina O.V., Setdikova G.R., Chekmareva I.A. Chronic pancreatitis or pancreatic ductal adenocarcinoma? Rossijskij medikobiologicheskij vestnik imeni akademika I.P. Pavlova. 2016; 25(1): 16–18. (in Russian)
18. Gubergrits N.B., Krylova E.A., Opihajlo M.S. Features of the histostructure of the pancreas in chronic pancreatitis. Jeksperimental'naja i klinicheskaja gastrojenterologija. 2019; 163(3): 38–42. (in Russian)
19. Ge Q.C., Dietrich C.F., Bhutani M.S., et al. Comprehensive review of diagnostic modalities for early chronic pancreatitis. World J Gastroenterol. 2021; 27(27). doi: 10.3748/wjg.v27.i27.4342.
20. Peng Y.P., Zhu X.L., Yin L.D., et al. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy. Sci Rep. 2017; 7. doi: 10.1038/s41598-017-00311-8.
21. Lee S.C., Hong T.H., Kim O.-H., et al. A novel way of preventing postoperative pancreatic fistula by directly injecting profibrogenic materials into the pancreatic parenchyma. Int J Mol Sci. 2020; 21(5). – doi: 10.3390/ijms21051759.
22. Issa Y., Kempeneers M.A., van Santvoort H.C., et al. Diagnostic performance of imaging modalities in chronic pancreatitis. Eur Radiol. 2017; 27. doi: 10.1007/s00330-016-4720-9.
23. Bystrovskaja E.V., Kim V.A., Orlova Yu.N., et al. Endoscopic Ultrasound in Diagnosing Pancreatic Disorders. Doktor.Ru. 2014; 3(91): 44–47.
24. Hashimoto Y., Sclabas G.M., Takahashi N., et. al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy. J Gastrointest Surg. 2011; 15. doi: 10.1007/s11605-011-1687-3.
25. Khatkov I.E., Tyulyaeva E.Yu., Les’ko K.A., et al. Early diagnosis of chronic pancreatitis. Almanac of Clinical Medicine. 2022; 50(6): 349–356. (in Russian)
26. Weiss F.U., Budde C., Lerch M.M., et al. Specificity of a polyclonal fecal elastase ELISA for CELA3. PLoS One. 2016; 11(7). doi: 10.1371/journal.pone.0159363.
27. Melton E., Qiu H. Interleukin-36 Cytokine / Receptor Signaling: a new target for tissue fibrosis. Int J Mol Sci. 2020; 21(18). doi: 10.3390/ijms21186458.
28. Manjari K.S., Nallari P., Vidyasagar A. Plasma TGF-b1, MMP-1 and MMP-3 levels in chronic pancreatitis. Ind J Clin Biochem. 2012; 27(2): 152–156.
29. Vinokurova L.V., Varvanina G.G., Smirnova A.V., et al. Specific features of matrix metalloproteinase level changes in pancreatic disorders. Doktor.Ru. 2017; 2(131): 33–37. (in Russian)
30. Les’ko K.A., Varvanina G.G., Bordin D.S., et al. New approaches to non-invasive diagnostics of pancreatic fibrosis in chronic pancreatitis. Doktor.Ru. 2020; 19(7): 6–14. (in Russian)
31. Pearson G., Robinson F., Beers G.T., et al. Mitogen activated protein (MAP) kinase pathways: regulation and physiological functions. Endocr Rev. 2001; 22(2): 153–183.
32. Yao Y., Li W., Wu J., et al. Extracellular signal-regulated kinase 2 is necessary for mesoderm differentiation. PNAS. 2003; 100. doi: 10.1073/pnas.2134254100.
33. Kitanaka N., Nakano R., Sakai M., et al. ERK1/ATF-2 signaling axis contributes to interleukin-1β-induced MMP-3 expression in dermal fibroblasts. PLoS One. 2019; 14(9). doi: 10.1371/journal.pone.0222869.
34. Pinskij S.B., Beloborodov V.A., Batoroev Yu.K. Neuroendocrine tumors of the pancreas. Sibirskij meditsinskij zhurnal (Irkutsk). 2013; 120(5): 12–17. (in Russian)
35. Del Toro-Arreola A., Robles-Murillo A.K., Daneri-Navarro A., Rivas-Carrillo J.D. The role of endothelial cells on islet function and revascularization after islet transplantation. Organogenesis. 2016; 12 (1): 28–32.
36. Yarets Yu.I., Malkov A.B. Neurospecific blood proteins in the diagnosis of preclinical forms of diabetic distal polyneuropathy. Problemy zdorov'ya i ekologii. 2018; 2: 60–66. (in Russian)
37. Hamed S., Metwalley K.A., Farghaly H.S., et al. Serum levels of neuron-specific enolase in children with diabetic ketoacidosis. J Clin Res Pediatr Endocrinol. 2019; 11(4): 374–387.
38. Zykin B.I., Postnova N.A., Medvedev M.E. Elastography: anatomy of the method. Promeneva dіagnostika, promeneva terapіja. 2012; 2–3: 107–113. (in Russian)
39. Ophir J., Cespedes I., Ponnekanti H., et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991; 13(2): 111–134.
40. Uchida H., Hirooka Y., Itoh A., et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas. 2009; 38: 17–22.
41. Kawada N., Tanaka S. Elastography for the pancreas: current status and future perspective. World J Gastroenterol. 2016; 22 (14). doi: 10.3748/wjg.v22.i14.3712.
42. Eiler J., Kleinholdermann U., Albers D., et al. Standard value of ultrasound elastographyusingacoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med. 2012; 33(5): 474–479.
43. Minling Zhuo, Xiujuan Zhang, Yi Tang, et al. Two-dimensional shear wave elastography of the pancreas: measurement success rate, repeatability, and factors affecting measurement values. J Med Ultrason. 2022; 49(2): 261–268.
44. Stepanov Yu.M., Gravirovskaja N.G. Initial results of the use of shear transient elastometry in determining the state of the pancreatic parenchyma (obzor literatury i sobstvennye issledovanija). Gastroenterologiya. 2015; 3: 53–58. (in Russian)
45. Arda K., Ciledag N., Aktas E., et al. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR. 2011; 197: 532–536.
46. Hiroyuki Kojima, Atsushi Sofuni, Katsutoshi Sugimoto, et al. Efficacy of shear wave elastography for the diagnosis of chronic pancreatitis. J Hepatobiliary Pancreat Sci. 2023; 30(3): 351–359.
47. Gal’perin E.I., Djuzheva T.G., Semenenkik I.A., et al. On the possibilities of ultrasound elastometry for diagnosing chronic pancreatitis. A full factorial experiment. Ul’trazvukovaya i funktsional’naya diagnostika. 2015, 2: 19–35. (in Russian)
48. Lee T.K., Kang C.M., Park M.S., et al. Prediction of postoperative pancreatic fistulas after pancreatectomy: assessment with acoustic radiation force impulse elastography. J Ultrasound Med. 2014; 33: 781–786.
49. Harada N., Ishizawa T., Inoue Y., et al. Acoustic radiation force impulse imaging of the pancreas for estimation of pathologic fibrosis and risk of postoperative pancreatic fistula. J Am Coll Surgeons. 2014; 219: 887–894.
50. Propp A.R., Degovtsov E.N. Comparative analysis of the results of various methods of pancreatic head resection in chronic pancreatitis. Zhurnal im. N. V. Sklifosovskogo “Neotlozhnaya medicinskaya pomoshch'” 2020; 9(2): 238–250. (in Russian)
51. Skube M.E., Beilman G.J. Surgical treatment of pain in chronic pancreatitis. Curr Opin Gastroenterol. 2018; 34(5): 317–321.
52. Tillou J.D., Tatum J.A., Jolissaint J.S., et al. Operative management of chronic pancreatitis. Am J Surg. 2017; 214(2): 347–57.
53. Dobrov S.D., Poljakovich A.S., Tolstyh B.N., et al. Biliary hypertension in patients with chronic pancreatitis. Annaly hirurgicheskoj gepatologii. 2012; 17(4): 35–55. (in Russian)
54. Kriger A.G., Ahtanin E.A., Zemskov V.M., et al. Risk factors and prevention of postoperative pancreatitis after pancreatectomy. Hirurgiya. 2016; 7: 4–10. (in Russian)
55. Kleeff J., Stoss C., Mayerle J., et al. Evidence-based surgical treatments for chronic pancreatitis. Dtsch Arztebl Int. 2016; 113(29– 30): 489–496.
56. Hat’kov I.E., Maev I.V., Abdulhakov S.R., et al. Russian consensus on the diagnosis and treatment of chronic pancreatitis. Terapevticheskij arhiv. 2017; 89(2): 105–113. (in Russian)
57. Ma L.W., Dominguez-Rosado I., Gennarelli R.L., et al. The cost of postoperative pancreatic fistula versus the cost of pasireotide. Ann Surg. 2016; 265: 11–16.
58. Pedrazzoli S., Liessi G., Pasquali C., et al. Postoperative pancreatic fistulas: preventing severe complicationsand reducing reoperation and mortality rate. Ann Surg. 2009; 249: 97–104.
59. Magge D.R., Zenati M.S., Hamad A., et al. Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open, laparoscopic, and robotic distal pancreatectomy. HPB (Oxford). 2018; 20(12): 1172–1180.
60. Yekebas E.F., Wolfram L., Cataldegirmen G., et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg. 2007; 246(2): 269–280.
61. Chincarini M., Zamboni G.A., Pozzi Mucelli R. Major pancreatic resections: normal postoperative findings and complications. Insights Imaging. 2018; 9(2): 173–187.
62. Kriger A.G., Gorin D.S., Goev A.A., et al. Postoperative bleeding in pancreatic surgery. Annaly hirurgicheskoj gepatologii. 2017; 22(2): 36–44. (in Russian)
63. Veligotskij N.N., Veligotskij A.N., Arutyunov S.E., et al. Experience of 200 pancreatoduodenectomies – evaluation of various anastomosis options. Annaly hirurgicheskoj gepatologii. 2015; 20(1): 100–105. (in Russian)
64. Rajn V.Yu., Kislitsin D.P., Chernov A.A., Bukir’ V.V. Early biliary complications of pancreaticoduodenal resection. Annaly hirurgicheskoj gepatologii. 2021; 26(4): 114–119. (in Russian)
65. Gal’perin E.I., Djuzheva T.G., Ahaladze G.G., et al. Chronic pancreatitis, resection and drainage interventions. Hirurgija. 2006; 8: 4–9. (in Russian)
66. Zi Yin, Jian Sun, Dong Yin, et al. Surgical treatment strategies in chronic pancreatitis. Arch Surg. 2012; 147: 961–968.
67. Shajmardanov R.Sh., Gubaev R.F., Hamzin I.I. Diagnostics and treatment of biliary hypertension syndrome in chronic pancreatitis. Kazanskij medicinskij zhurnal. 2016; 97(6): 828–832. (in Russian)
68. Ueda J., Miyasaka Y., Ohtuka T., et al. Short- and long-term results of the Frey procedure for chronic pancreatitis. J Hepatobiliary Pancreat Sci. 2015; 22: 211–216.
Review
For citations:
Glyzdou A., Arlouski Yu. Modern aspects of diagnosis, prevention and treatment of complications after resection and drainage operations on the pancreas in chronic pancreatitis. Healthcare. 2025;(12):39-52. (In Russ.) https://doi.org/10.65249/1027-7218-2025-12-39-52
JATS XML
