Pancreatology最新文献

{"title":"Low-dose aspirin use is associated with reduced 30- and 90-day mortality and overall improved outcomes in patients with acute pancreatitis: A multinational multicenter analysis.","authors":"Do Han Kim, Donghyun Ko, Carlos Elizondo Alatorre, Frank J Lukens, Jose A Porres, Pedro Palacios Argueta, Massimo Raimondo, Baoan Ji, Yan Bi, Paul T Kröner","doi":"10.1016/j.pan.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.022","url":null,"abstract":"<p><strong>Introduction: </strong>Studies regarding outcomes in patients with acute pancreatitis (AP) on aspirin (ASA) have shown conflicting results. This study aims to evaluate the association between low-dose ASA and clinical outcomes in patients with AP at 30 and 90 days.</p><p><strong>Methods: </strong>This retrospective cohort study used Global Research Network from TriNetX. Patients with AP on low-dose ASA were matched 1:1 with non-ASA users by demographics and comorbidities. Outcomes included mortality, shock, intensive care unit (ICU) admission, mechanical ventilation, venous thromboembolism (VTE), acute kidney injury (AKI), pancreatic pseudocyst formation, development of necrotizing pancreatitis, and recurrent AP. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated at 30 and 90 days.</p><p><strong>Results: </strong>A total of 240 720 patients with AP were identified of which 12 634 were ASA users. 12 389 ASA users (mean age 60.4 years, 48.8 % female) were matched with 12 389 non-users (mean age 60.7 years, 48.4 % female). ASA users had lower risk of 30-day mortality (HR: 0.53, 95 %CI: 0.43-0.64), shock (HR: 0.57, 95 %CI: 0.37-0.88), ICU admission (HR: 0.71, 95 %CI: 0.56-0.89), VTE (HR: 0.38, 95 %CI: 0.24-0.60), AKI (HR: 0.69, 95 %CI: 0.59-0.80), and recurrent AP (HR: 0.64, 95 %CI: 0.60-0.67). Similar trends were observed at 90 days.</p><p><strong>Conclusion: </strong>Low-dose ASA was associated with lower mortality, fewer complications, and lower recurrence in patients with AP, as compared to patients without ASA use at 30- and 90-days. These findings may suggest that ASA's anti-inflammatory and antiplatelet properties could potentially mitigate the inflammatory cascade in AP pathophysiology. Further studies are warranted to explore the direct impact of ASA on AP.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of futile surgery in upfront resectable pancreatic ductal adenocarcinoma. possible targets for neoadjuvant chemotherapy?","authors":"Melroy D'Souza, Allan Feili, Oskar Swartling, Omid Sadr-Azodi, Marcus Holmberg","doi":"10.1016/j.pan.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.025","url":null,"abstract":"<p><strong>Background: </strong>Upfront resectable pancreatic ductal adenocarcinoma (PDAC) with evidence of disseminated disease (metastasis at surgery or recurrence within 6 months after resection) impacts outcome negatively. Neoadjuvant chemotherapy for localized PDAC has not been shown to yield the anticipated outcomes, but resectable tumours at high risk for dissemination may be suitable candidates. This study aims to identify preoperative characteristics of resectable PDAC associated with evidence of dissemination.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre study of adult patients with upfront resectable PDAC who underwent exploration or resection at the Karolinska University Hospital between 2009 and 2018. Multivariable logistic regression analysis was used to identify predictors for dissemination. Nomograms for dissemination were developed. Tumours with high and low risk for dissemination according to the nomogram were compared using Kaplan-Meier survival curves.</p><p><strong>Results: </strong>In total 393 patients were included in the study, 105 with disseminated tumours, 186 that recurred between 6 and 24 months and 102 that had not recurred within 24 months. Independent predictors for disseminated disease for tumours in the pancreatic head and in the body/tail were CA19-9 ≥200 U/mL, and CA19-9 ≥100 U/mL as well as tumour size ≥20 mm respectively.</p><p><strong>Conclusion: </strong>Preoperative assessment of resectable PDAC for predictors of disseminated disease may guide the selection of patients suitable for upfront resection or those that may benefit from neo-adjuvant chemotherapy.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and risk factors of invasive candidiasis in patients with infected pancreatic necrosis.","authors":"Tingting Liu, Gang Li","doi":"10.1016/j.pan.2025.09.019","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.019","url":null,"abstract":"<p><strong>Background: </strong>Invasive candidiasis in patients with infected pancreatic necrosis (IPN) can lead to severe morbidity and mortality. However, there is still limited information regarding clinical characteristics, antifungal efficacy and prognosis of these patients.</p><p><strong>Purpose: </strong>This study aimed to identify factors associated with antifungal therapy failure and mortality in IPN patients complicated by invasive candidiasis.</p><p><strong>Methods: </strong>This single-center, retrospective study included IPN patients admitted between January 2022 and April 2024 who were diagnosed with invasive candidiasis, defined as either candidemia or localized pancreatic fungal infection confirmed by a positive Candida culture from an aseptically collected pancreatic or peripancreatic necrotic tissue specimen. The primary outcomes were the efficacy of antifungal therapy at day 7 and at the end of intravenous treatment, as well as 28-day all-cause mortality. Logistic regression analysis was employed to identify risk factors associated with antifungal therapy failure or mortality.</p><p><strong>Results: </strong>Among 815 IPN patients, 114 (14.0 %) developed invasive candidiasis. Of these, 60.5 % had candidemia with or without pancreatic fungal infection, and 39.5 % had isolated pancreatic fungal infection. Antifungal therapy was effective in 38.6 % of patients at day 7 and in 63.2 % at the end of intravenous treatment. The 28-day all-cause mortality rate was 12.9 %. Logistic regression analysis demonstrated that breakthrough fungal infection was significantly associated with antifungal therapy failure at day 7 (OR 2.906, 95 % CI 1.232-6.858, p = 0.015). Septic shock at the time of first positive culture (OR 5.416, 95 % CI 2.006-14.623, p = 0.001) and isolated pancreatic fungal infection (OR 3.090, 95 % CI 1.106-8.630, p = 0.031) were significantly associated with antifungal therapy failure at the end of intravenous treatment. Multiple organ dysfunction syndrome was identified as an independent risk factor for 28-day mortality (OR 21.224, 95 % CI 2.550-176.627, p = 0.005).</p><p><strong>Conclusion: </strong>IPN Patients complicated by invasive candidiasis exhibited a relatively low overall response to antifungal therapy. Breakthrough fungal infection was identified as an independent risk factor for early therapy failure, while septic shock and isolated pancreatic fungal infection were significantly associated with therapy failure at the end of intravenous therapy. Multiple organ dysfunction syndrome was an independent predictor of 28-day mortality.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The distance to arteries predicts the oncological outcome in pancreatic cancer surgery - results from a 3D reconstruction model.","authors":"Carola Focke, Michael Uhl, Dietrich A Ruess, Sophia Chikhladze, Stefan Fichtner-Feigl, Fabian Bamberg, Jakob Neubauer, Uwe A Wittel","doi":"10.1016/j.pan.2025.09.024","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.024","url":null,"abstract":"<p><strong>Background: </strong>Many patients will experience recurrence after oncological pancreatic resection. The success of complete curative resection largely depends on the tumor's proximity to surrounding arteries, such as the celiac axis (CA) and the superior mesenteric artery (SMA). Predicting oncological outcomes before surgery remains a major challenge.</p><p><strong>Methods: </strong>This retrospective study included patients with histologically proven pancreatic ductal adenocarcinoma (PDAC) who underwent pancreatic resection. Preoperative contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) was used to determine the shortest distance between the tumor and the corresponding artery. The cohort was subdivided into three groups: direct contact (representing borderline resectability), close proximity (>0 to ≤5 mm), and greater distance (>5 mm) between the tumor and the closest artery. An analysis of the oncological outcomes for each group was performed.</p><p><strong>Results: </strong>Among the 180 included patients, the direct contact group was associated with an increased rate of local recurrence (46.9 %) compared to the close proximity and greater distance groups (41.0 % and 38.6 %, respectively). The R1 resection rates were also significantly higher in the direct contact group (38.6 % vs. 23.0 % and 20.0 %, respectively; p < 0.05). In the survival analysis, patients with a greater distance had a significantly longer time to recurrence (15.4 vs. 10.8 vs 6.5 months) and median overall survival (33.7 vs. 20.8 vs. 14.0 months) than patients with close proximity or contact to the nearest artery.</p><p><strong>Conclusion: </strong>Measurement of the distance to the closest artery in preoperative imaging has strong prognostic value for recurrence and overall survival in patients with resectable PDAC.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A model to predict participant retention in longitudinal acute pancreatitis studies.","authors":"Ila Lahooti, Lydia Noh, Melica Nikahd, Kathleen Tong, Anna Evans Phillips, Stacey Culp, Matthew Yoder, Patrick Rowan, Vikesh K Singh, Elham Afghani, Ali Lahooti, Philip A Hart, Erica Park, Somashekar G Krishna, Raj Shah, Mitchell L Ramsey, Georgios I Papachristou, Peter J Lee","doi":"10.1016/j.pan.2025.09.020","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.020","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and impact of sarcopenia in chronic pancreatitis: A systematic review and meta-analysis.","authors":"Mohamed Abdulla Ghuloom Abdulla Bucheeri, Kareem Khalaf, Huaqi Li, Yuhong Yuan, Daniel Tham, Reyana Jayawardena, Balqis Alabdulkarim, Jeffrey D Mosko, Christopher W Teshima, Gary R May, Natalia Causada Calo","doi":"10.1016/j.pan.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.026","url":null,"abstract":"<p><strong>Background: </strong>Chronic pancreatitis (CP) is a progressive inflammatory disease leading to irreversible pancreatic damage, resulting in exocrine and endocrine insufficiency. While surgical and endoscopic interventions can address morphological complications of CP, they may not directly address the systemic impacts of malnutrition, frailty, and sarcopenia-key contributors to morbidity and mortality in these patients. This systematic review and meta-analysis aimed to evaluate the prevalence of sarcopenia in CP patients.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Embase databases (via Ovid, from inception to November 2024) was conducted following PRISMA guidelines. Studies reporting sarcopenia prevalence in CP, assessed by various diagnostic modalities, were included. Random-effects pooled proportion meta-analysis using the Freeman-Tukey double arcsine transformation were applied. Heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>Fifteen studies with 1365 CP patients were included. Most patients were male (68 %), with about half having a history of alcohol misuse and smoking (48 %, 52.5 %, respectively). About 47 % had pancreatic exocrine insufficiency, with 41 % being on pancreatic enzyme replacement therapy. Mortality was assessed in a single study and reported at 16 %. The pooled prevalence of sarcopenia was 40.9 % [95 % CI: 28.4 %-58.9 %]. The pooled mean difference for BMI between sarcopenic and non-sarcopenic patients was -2.62 (95 % CI: 3.22 to -2.01, p < 0.01).</p><p><strong>Conclusion: </strong>This highlights that approximately 41 % of patients with CP have sarcopenia, and that this seems to be associated with a low BMI. Given the known adverse impact of sarcopenia on overall health, future studies should focus on standardizing sarcopenia screening, assessment and exploring its interplay with outcomes in CP patients.</p><p><strong>Prospero: </strong>CRD42024611097.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated expression of circular RNA circ0001415 attenuates acinar cell pyroptosis during acute pancreatitis.","authors":"Yan Zhang, Shaolong Hao, Fang Nie, Hao Sun, Wenxiu Zhang, Lang Ji, Jiahui Qi, Ziyu Zhang, Wei Han","doi":"10.1016/j.pan.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.007","url":null,"abstract":"<p><strong>Introduction: </strong>Pyroptosis, a form of inflammatory programmed cell death, is implicated in acute pancreatitis (AP). Acinar cell pyroptosis plays a pivotal role in the pathogenesis of AP. Circular RNA has emerged as an important regulatory molecule in AP; however, its specific function and mechanism in modulating acinar cell pyroptosis during AP are unknown.</p><p><strong>Methods: </strong>Healthy male C57BL/6 mice were divided into control group and acute pancreatitis group. Cell experiments are also divided into two groups: control group and drug-treated (caerulein and lipopolysaccharide) group. Tissue detection was used hematoxylin-eosin staining. Serum analysis was assessed by Enzyme-linked immunosorbent assay (ELISA). Differential expression of circRNA in pancreatic head tissue was screened using RNA-sequencing and circ0001415 was validated by real-time PCR. immunofluorescence, Western blot assay, ELISA, and real-time PCR were performed to detect cell pyroptosis in the mice and caerulein and lipopolysaccharide-induced pancreatic acinar cell line MPC-83 cell models. Gene knockdown and Luciferase reporter assay was used to confirm the regulatory role of circRNA0001415 in acinar cell pyroptosis.</p><p><strong>Results: </strong>We found that circ0001415 is significantly upregulated in the pancreatic head tissue of these mice. Subsequent experiments indicated that circ0001415 likely serves as a molecular sponge for microRNA-1946a, thereby potentially enhancing the expression levels of the pyroptosis-associated protein caspase 1. Consequently, circ0001415 upregulation appears to counteract the decrease in acinar cell pyroptosis observed in AP. In vitro studies revealed that the knockdown of circ0001415 intensified the pyroptosis of acinar cells induced by lipopolysaccharide and caerulein.</p><p><strong>Conclusion: </strong>These findings provide novel insights suggesting that the upregulation of circ0001415 may serve as a protective mechanism against the dampening effects on acinar cell pyroptosis following AP. Overall, circ0001415 is a potential molecular target for AP treatment.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative aerobic fitness is a predictor of postoperative outcomes in patients undergoing pancreatoduodenectomy.","authors":"Allard G Wijma, Bart C Bongers, Mayella Kuikhoven, Frederik J H Hoogwater, Maarten W Nijkamp, Joost M Klaase","doi":"10.1016/j.pan.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.023","url":null,"abstract":"<p><strong>Background: </strong>In various surgical cancer populations, a clear association has been reported between low preoperative aerobic fitness and poor postoperative outcomes. Yet, in pancreatic surgery, postoperative complications are mainly linked to pancreatic texture and duct diameter, and the role of aerobic fitness remains unclear.</p><p><strong>Methods: </strong>Patients referred for pancreatoduodenectomy at the University Medical Center Groningen were screened for low aerobic fitness using a questionnaire and referred for cardiopulmonary exercise testing (CPET) for aerobic fitness assessment accordingly. Based on CPET results, patients were classified as unfit when they had an oxygen uptake (VO₂) at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or a VO₂ at peak exercise ≤18 ml/kg/min. All patients received an advice to be physically active preoperatively and postoperative outcomes were compared to fit patients.</p><p><strong>Results: </strong>Of 175 screened patients, 120 (68.6 %) were considered at risk for low aerobic fitness and underwent preoperative CPET. After excluding patients who participated in a supervised prehabilitation program, 106 CPET reports were used in the analysis. Forty-four (41.5 %) patients were classified as unfit. Postoperatively, unfit patients had a higher rate of gastroparesis grade ≥ B complications (40.9 % versus 22.6 % in fit patients, p = 0.043), and a prolonged length of stay (13 days versus 11 days in fit patients, p = 0.014).</p><p><strong>Conclusions: </strong>Low preoperative aerobic fitness is prevalent in patients undergoing pancreatoduodenectomy and a predictor of impaired postoperative outcomes. Aerobic fitness should therefore be included in the preoperative work-up and optimized accordingly in unfit patients scheduled to undergo pancreatoduodenectomy.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of pancreatic fibrosis in patients with recurrent acute and chronic pancreatitis.","authors":"Aida A Metri, Mahya Faghih, Elizabeth Thompson, Michael Noë, Rifat Mannan, Rita Kalyani, Erika Gunzelman, Elham Afghani, Lara Cheesman, Venkata S Akshintala, Merve Gurakar, Zahra Yousefli, Daniel Warren, Niraj M Desai, Zhaoli Sun, Christi Walsh, Martin A Makary, Ralph H Hruban, Jin He, Atif Zaheer, Vikesh K Singh","doi":"10.1016/j.pan.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.021","url":null,"abstract":"<p><strong>Objectives: </strong>Fibrosis is considered the criterion standard for diagnosing chronic pancreatitis (CP) but adequate tissue specimens are difficult to obtain, carry risk and are often obtained at the time of surgery in advanced stages of CP. Noninvasive biomarkers that correlate with fibrosis across the continuum of pancreatitis are needed. Our aim was to determine which clinical variables are associated with fibrosis in patients with recurrent acute pancreatitis (RAP) or CP undergoing total pancreatectomy with islet autotransplantation (TPIAT).</p><p><strong>Methods: </strong>The demographic, clinical and radiologic data for patients undergoing TPIAT for RAP or CP between 2011 and 2023 were reviewed. Excisional biopsies from the proximal and distal pancreas were each scored from 0 to 6 for both perilobular and intralobular fibrosis, and the score of each biopsy was the sum of perilobular and intralobular fibrosis (0-12). The fibrosis score (FS), ranging from 0 to 12, was the mean FS from the proximal and distal pancreas.</p><p><strong>Results: </strong>There were 88 patients with a mean age 38 ± 14 years and 46 (52.3 %) were female. There were 35 (39.8 %) and 53 (60.2 %) with RAP and CP, respectively. Genetic (52.3 %) and idiopathic (37.5 %) were the most common etiologies. The mean FS was 6.52 ± 3.53. Large duct CP (β = 3, p = 0.001), exocrine pancreatic insufficiency (EPI) (β = 1.5, p = 0.037) and a genetic etiology (β = 1.6, p = 0.03) were significant predictors of fibrosis after adjusting for age, BMI, disease duration and use of oral hypoglycemic drugs and/or insulin.</p><p><strong>Conclusion: </strong>Large duct CP, genetic etiology and EPI are all independent predictors of pancreatic fibrosis in a cohort of patients undergoing TPIAT. Computed tomography (CT) imaging and fecal elastase-1 (FE-1) concentration may be sufficient to estimate fibrosis without acquisition of a tissue specimen.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total pancreatectomy with islet auto-transplantation in pediatric patients results in significantly decreased opioid use, improved long-term pain and quality of life outcomes.","authors":"Cheryl J Hartzell, Juan P Gurria, Kenneth R Goldschneider, David S Vitale, Alexandra Szabova, Peter R Farrell, Kristin L Rich, Phoebe Christian, Qing Duan, Lili Ding, Greg Tiao, Maisam Abu-El-Haija","doi":"10.1016/j.pan.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.pan.2025.09.018","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pancreatitis (CP) and acute recurrent pancreatitis (ARP) cause significant morbidity in pediatric patients and may be candidates for total pancreatectomy with islet auto-transplantation (TPIAT). We examined opioid use and pain outcomes in a large cohort of pediatric patients post-TPIAT at a single institution.</p><p><strong>Methods: </strong>Prospective data was collected from 105 pediatric patients from 2015 to 2023 with at least 12 months post-operative data available, up to 5 years. Number of patients at each time point dependent on time from surgery, with median time point 36 months post-TPIAT (70.5 % of patients).</p><p><strong>Results: </strong>Opioid use significantly decreased from 55 % of patients pre-TPIAT (58/105) to 4 % at 12 months post-TPIAT (4/103, p < 0.001), sustained over time with no patients requiring opioids at 60 months (0/23). 60 % of patients with abdominal pain pre-TPIAT (93/105) reported complete resolution of pain at 3 months (48/102, p < 0.001), with downtrend over time, sustained through 60 months (4/25, 16 %). SF-36 physical component summary and SF-10 physical health and psychosocial summaries showed significant improvement over time post-TPIAT (p < 0.0001). Univariable analysis showed no significant association between post-TPIAT opioid use at 12 months and age at TPIAT, gender, duration from first pancreatitis attack to TPIAT, number of endoscopic retrograde cholangiopancreatographies pre-TPIAT, or diagnosis of CP. PRSS1 mutation more likely to have resolution of abdominal pain at 12 months (p = 0.005).</p><p><strong>Conclusions: </strong>Utilizing a standardized multidisciplinary approach to TPIAT in pediatric patients with pancreatitis showed significant decreases in opioid use and abdominal pain, regardless of severity of disease, pain, or opioid use pre-TPIAT.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}