This article provides an up-to-date review of the management of chronic pancreatitis, highlighting advancements in medical therapy, nutritional support, endoscopic and surgical approaches, and emerging treatments. Nutritional management accentuates addressing malabsorption and nutrient deficiencies. Advances in endoscopy and parenchyma-sparing surgical techniques have opened new avenues for improved patient outcomes, with total pancreatectomy and islet autotransplantation offering the only definitive solution for selected patients. Additionally, emerging therapies, including anti-inflammatory and immune-modulating agents, show promise for future treatment options. Emphasizing a multidisciplinary approach, this review aims to equip health care professionals with a comprehensive overview of current management strategies and future directions.

• MeSH
• Pancreatitis, Chronic * therapy   MeSH
• Humans MeSH
• Nutritional Support * methods   MeSH
• Pancreatectomy * methods   MeSH
• Islets of Langerhans Transplantation methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Souhrn Úvod: Se zavedením robotického systému Da Vinci Xi došlo k exponenciálnímu rozvoji roboticky asistovaných operačních intervencí. Benefity robotické chirurgie jsou úspěšně využívány i v oblasti pankreatické chirurgie. Prezentujeme kazuistiku 24leté pacientky se solidní pseudopapilární neoplazií pankreatu operované s využitím tohoto robotického systému. Kazuistika: Mladá pacientka se symptomatickou solidní pseudopapilární neoplazií kaudy pankreatu podstoupila roboticky asistovanou slezinu zachovávající distální pankreatektomii dle Kimury. Operace proběhla dle plánu s využitím robotického systému Da Vinci Xi nekomplikovaně. Pooperační průběh byl hladký s následnou dimisí do domácí péče 6. pooperační den. Další pooperační vývoj byl příznivý a pacientka je 6 měsíců po operaci v celkově dobrém stavu a bez obtíží. Závěr: Roboticky asistované operace přináší i do oblasti pankreatické chirurgie řadu výhod, kterých lze pomocí robotického systému bezpečně a miniinvazivně dosáhnout i v anatomicky nepříznivém terénu. I přes svou technickou náročnost je bezpečnou metodou v řešení benigních a low-grade maligních pankreatických neoplazií.

Summary Introduction: With the introduction of the Da Vinci Xi robotic system, there has been an exponential development of robot-assisted surgical interventions. The benefits of robotic surgery are also successfully used in the field of pancreatic surgery. We present a case report of a 24-year-old female with solid pseudopapillary neoplasia of the pancreas operated on using this robotic system. Case report: A young female patient with symptomatic solid pseudopapillary neoplasia of the cauda of the pancreas underwent robot-assisted spleen-preserving distal pancreatectomy (the Kimura procedure). The operation was performed according to the plan with the use of the Da Vinci Xi robotic system without complications. The postoperative course was smooth with subsequent discharge on the sixth postoperative day. Further postoperative development was favorable and the patient is in good general condition six months after the operation. Conclusion: Robot-assisted surgical procedures also bring a number of advantages to the field of pancreatic surgery, which can be achieved safely and minimally invasively even in anatomically unfavorable terrain with the help of a robotic system. Although presenting a technically challenging method, it is a safe method in the treatment of benign and low-grade malignant pancreatic neoplasia.

• Keywords
• distální pankreatektomie, pankreatická neoplazie,
• MeSH
• Adult MeSH
• Humans MeSH
• Pancreatic Neoplasms * surgery   MeSH
• Pancreas surgery   pathology   MeSH
• Pancreatectomy methods   MeSH
• Robotic Surgical Procedures * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

OBJECTIVE: To validate the prognostic value of the PAncreatic NeoAdjuvant MAssachusetts (PANAMA) score and to determine its predictive ability for survival benefit derived from adjuvant treatment in patients after resection of pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant FOLFIRINOX. BACKGROUND: The PANAMA score was developed to guide prognostication in patients after neoadjuvant therapy and resection for PDAC. As this score focuses on the risk for residual disease after resection, it might also be able to select patients who benefit from adjuvant after neoadjuvant therapy. METHODS: This retrospective international multicenter study is endorsed by the European-African Hepato-Pancreato-Biliary Association. Patients with PDAC who underwent resection after neoadjuvant FOLFIRINOX were included. Mantel-Cox regression with interaction analysis was performed to assess the impact of adjuvant chemotherapy. RESULTS: Overall, 383 patients after resection of PDAC following neoadjuvant FOLFIRINOX were included of whom 187 (49%), 137 (36%), and 59 (15%) had a low-risk, intermediate-risk, and high-risk PANAMA-score, respectively. Discrimination in median overall survival (OS) was observed stratified by risk groups (48.5, 27.6, and 22.3 months, log-rank Plow-intermediate = 0.004, log-rank Pintermediate-high = 0.027). Adjuvant therapy was not associated with an OS difference in the low-risk group [hazard ratio (HR): 1.50, 95% CI: 0.92-2.50], whereas improved OS was observed in the intermediate (HR: 0.58, 95% CI: 0.34-0.97) and high-risk groups (HR: 0.47, 95% CI: 0.24-0.94; P interaction = 0.008). CONCLUSIONS: The PANAMA 3-tier risk groups (low-risk, intermediate-risk, and high-risk, available through pancreascalculator.com) correspond with differential survival in patients with resected PDAC following neoadjuvant FOLFIRINOX. The risk groups also differentiate between survival benefits associated with adjuvant treatment, with only the intermediate- and high-risk groups associated with improved OS.

• MeSH
• Chemotherapy, Adjuvant MeSH
• Adult MeSH
• Carcinoma, Pancreatic Ductal * mortality   therapy   drug therapy   surgery   MeSH
• Fluorouracil therapeutic use   MeSH
• Risk Assessment MeSH
• Irinotecan therapeutic use   MeSH
• Leucovorin therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Survival Rate MeSH
• Pancreatic Neoplasms * mortality   therapy   drug therapy   surgery   MeSH
• Neoadjuvant Therapy MeSH
• Oxaliplatin therapeutic use   MeSH
• Pancreatectomy * MeSH
• Prognosis MeSH
• Antineoplastic Combined Chemotherapy Protocols * therapeutic use   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Validation Study MeSH

IMPORTANCE: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide. OBJECTIVE: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). DESIGN, SETTING, AND PARTICIPANTS: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging. EXPOSURES: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection. MAIN OUTCOMES AND MEASURES: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS. RESULTS: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04). CONCLUSION AND RELEVANCE: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

• MeSH
• Carcinoma, Pancreatic Ductal * surgery   mortality   diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local * MeSH
• Survival Rate MeSH
• Pancreatic Neoplasms * surgery   mortality   MeSH
• Follow-Up Studies MeSH
• Pancreatectomy * MeSH
• Prospective Studies MeSH
• Cross-Sectional Studies MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

Úvod: Karcinom pankreatu je jedním z nejagresivnějších nádorových onemocnění, které je ve více než v polovině případů diagnostikováno v lokálně pokročilém nebo metastatickém stadiu. Prognóza těchto nemocných je velmi špatná. Standardním postupem je paliativní chemoterapie prodlužující život nemocných s mediánem celkového přežití méně než 1 rok. Existuje však vybraná skupina oligometastatických pacientů, která může profitovat z resekčního výkonu. Vzhledem k tomu, že se jedná o poměrně malou část pacientů, chybí nám v současnosti rozsáhlé klinické studie přesně definující strategii, efektivitu a bezpečnost tohoto postupu. Kazuistika: Sedmdesátisedmiletý muž s duktálním adenokarcinomem kaudy pankreatu a solitární metastázou v játrech. Po čtyřech cyklech chemoterapie byla provedena distální pankreatektomie s jaterní metastazektomií. Kompletní patologická odpověď byla nalezena v primárním nádoru a reziduálním adenokarcinomu v jaterní metastáze. Následně indikovaná adjuvantní chemoterapie gemcitabinem musela být ukončena při druhém cyklu pro hematologickou toxicitu a intoleranci a pacient v kompletní remisi nemoci je nadále dispenzarizován. Výsledky: Pacient žije bez recidivy více než 2 roky od stanovení diagnózy.

Introduction: Pancreatic cancer is one of the most aggressive tumors diagnosed in locally advanced or metastatic stage in more than half of the cases. The standard of care is a systemic chemotherapy but the prognosis of metastatic patients remains extremely poor with a median overall survival less than one year. However, there is increasing evidence of surgery treatment benefit in a carefully selected oligometastatic cases. Because oligometastatic pancreatic cancer is rare, there is a lack of robust clinical trials defining strategy, efficacy and safety of this procedure. Patient concerns: A 77-year-old man presented with a mass in the tail of the pancreas and solitary liver metastasis. After four cycles of chemotherapy, distal pancreatectomy with liver metastasectomy was performed, and the tissues were histologically examined. The complete pathological response was found in the primary tumor and residual adenocarcinoma in liver metastasis. Outcomes: The patient is alive without recurrency more than two years from the diagnosis.

• MeSH
• Adenocarcinoma surgery   diagnostic imaging   therapy   MeSH
• Humans MeSH
• Metastasectomy MeSH
• Neoplasm Metastasis therapy   MeSH
• Liver Neoplasms surgery   secondary   MeSH
• Pancreatic Neoplasms * surgery   diagnostic imaging   therapy   MeSH
• Neoadjuvant Therapy * MeSH
• Pancreatectomy MeSH
• Antineoplastic Combined Chemotherapy Protocols MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

Pankreatoprivní diabetes je sekundární forma se stejnou prevalencí v evropské populaci jako diabetes mellitus 1. typu. Nejčastější příčinou je chronická pankreatitida, se kterou úzce souvisí i resekční výkony. Extrémně labilní formou je diabetes po totální pankreatektomii. Tento typ diabetu je charakterizován častým výskytem hypoglykemií, a to i těžkých epizod. Účinnou prevenci vzniku diabetu je autotransplantace ostrůvků, která se provádí od roku 1980. Tato léčba efektivně brání vzniku diabetu u třetiny pacientů a u ostatních nemocných významně snižuje výskyt hypoglykemií. Pokud tento výkon nelze provést, je vhodné pacienty monitorovat pomocí senzorů a pokusit se je léčit hybridními smyčkami. V budoucnu přicházejí do úvahy také bihormonální pumpy.

Pancreaticobiliary diabetes is a secondary form with the same prevalence in the European population as type 1 diabetes mellitus. The most common cause is chronic pancreatitis, with which resection procedures are closely related. An extremely labile form is diabetes after total pancreatectomy. This type of diabetes is characterized by frequent occurrence of hypoglycemia and even severe episodes. An effective prevention of diabetes is islet autotransplantation, which has been performed since 1980. This treatment effectively prevents diabetes in one third of patients and significantly reduces the incidence of hypoglycemia in the remaining patients. If this procedure cannot be performed, it is advisable to monitor patients with sensors and try to treat them with hybrid loops.

• MeSH
• Transplantation, Autologous methods   MeSH
• Pancreatitis, Chronic surgery   MeSH
• Diabetes Mellitus etiology   therapy   MeSH
• Hypoglycemia etiology   prevention & control   MeSH
• Humans MeSH
• Pancreatectomy * methods   adverse effects   MeSH
• Islets of Langerhans Transplantation methods   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Conservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis. METHODS: All patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared. RESULTS: Thirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group. CONCLUSIONS: Both pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.

• MeSH
• Pancreatitis, Chronic * surgery   MeSH
• Operative Time * MeSH
• Length of Stay statistics & numerical data   MeSH
• Adult MeSH
• Duodenum surgery   pathology   MeSH
• Organ Sparing Treatments methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality MeSH
• Pancreas * surgery   pathology   MeSH
• Pancreatectomy methods   adverse effects   MeSH
• Pancreaticoduodenectomy * methods   adverse effects   MeSH
• Postoperative Complications etiology   epidemiology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Humans MeSH
• Adenocarcinoma, Mucinous surgery   diagnosis   MeSH
• Pancreatic Neoplasms * classification   therapy   MeSH
• Pancreatectomy methods   MeSH
• Check Tag
• Humans MeSH

Karcinom pankreatu je nádorové onemocnění se špatnou prognózou, které představuje třetí nejčastější příčinu úmrtí na zhoubný nádor ve vyspělých zemích a jehož incidence a mortalita dle predikcí nadále významným způsobem porostou. Téměř 80 % pacientů je diagnostikováno s pokročilým onemocněním a je tudíž odkázáno na paliativní protinádorovou léčbu s limitovanou účinností. Avšak i u 10-20 % nemocných s lokalizovaným karcinomem pankreatu, kteří úspěšně absolvovali radikální resekci a následnou adjuvantní chemoterapii, obvykle dojde k relapsu do 2-3 let od operace. Příčiny lze hledat v pozdním stanovení diagnózy, v komplikované anatomické lokalizaci, ve výrazné nádorové heterogenitě znesnadňující testování nových léčiv a v neposlední řadě i v přítomnosti denzního nádorového stromatu znesnadňujícího přístup jak cytostatik, tak i cílených léčiv do nádorové tkáně. V tomto sdělení uvádíme souhrn aktuálních možností diagnostiky a léčby lokalizovaných i pokročilých forem karcinomu pankreatu včetně možností molekulární diagnostiky a cílené léčby podskupin.

Pancreatic ductal adenocarcinoma is a cancer disease with a very poor prognosis, which poses the third-leading cause of cancer-related deaths and whose incidence and mortality have been predicted to increase significantly in the upcoming years. Almost 80% of patients are diagnosed with advanced unresectable disease and therefore rely on palliative anticancer treatment with limited efficacy. However, even in case of 10-20 % of patients who have successfully undergone radical surgical resection of the localized disease and subsequent adjuvant chemotherapy, the vast majority will relapse within 2-3 years of surgery. The reasons can be found in late diagnosis due to the prolonged clinically asymptomatic course of the disease, complicated anatomical localization, significant tumor heterogeneity, which makes it difficult to test new drugs and, last but not least, in the presence of dense tumor stroma, that complicates the access of cytostatics and targeted drugs into the tumor tissue. Here we present a summary of current treatment options of localized and advanced pancreatic cancer, including molecular diagnostics and targeted treatment of small patients subgroups.

• MeSH
• Molecular Targeted Therapy * methods   MeSH
• Drug Therapy methods   MeSH
• Immunotherapy methods   MeSH
• Humans MeSH
• Pathology, Molecular methods   MeSH
• Pancreatic Neoplasms * diagnosis   drug therapy   pathology   MeSH
• Pancreatectomy methods   MeSH
• Check Tag
• Humans MeSH

• Keywords
• pankreatoskopie,
• MeSH
• Cholangiopancreatography, Endoscopic Retrograde MeSH
• Endosonography MeSH
• Middle Aged MeSH
• Humans MeSH
• Lecithin Cholesterol Acyltransferase Deficiency diagnostic imaging   MeSH
• Pancreas * diagnostic imaging   pathology   MeSH
• Pancreatectomy MeSH
• Pancreatitis complications   MeSH
• Pancreatic Ducts diagnostic imaging   pathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH