{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:17:35Z","timestamp":1788495455096,"version":"build-2803163510"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/ http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objective:<\/jats:title>\n To evaluate the use and impact of current surgical guidelines for chronic pancreatitis (CP) across Europe.<\/jats:p>\n <\/jats:sec>\n \n Summary Background Data:<\/jats:title>\n Current guidelines recommend morphology-based surgery for CP, but international studies evaluating their use and impact are lacking.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Post hoc analysis of the prospective multicenter ESCOPA study, including patients undergoing surgery for symptomatic CP at 22 centers in 13 countries (June 2021\u2013November 2022), with 6-month follow-up. Patients were stratified by morphologic subtype: \u201cisolated dilated main pancreatic duct (MPD),\u201d \u201cisolated enlarged pancreatic head (PH),\u201d \u201ccombined dilated MPD and enlarged PH,\u201d and \u201csmall duct disease.\u201d Treatment was based on the European HaPanEU and International IAP-APA-JPS-EPC guidelines. Primary outcomes were 90-day major morbidity, mortality, and pain relief at 6 months. Practice variation was assessed, including a case-based survey.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Overall, 207 patients were included following surgery for CP, with 1.4% 90-day mortality and 72.6% pain relief. The surgical approach varied widely by morphologic subtype: duodenum-preserving pancreatic head resections (DPPHR) were most common for \u201ccombined dilated MPD and enlarged PH\u201d (46.8%,\n P<\/jats:italic>\n =0.016); whereas formal pancreatectomy predominated for \u201cisolated dilated MPD\u201d (63.3%,\n P<\/jats:italic>\n =0.040) and \u201csmall duct disease\u201d (66.0%,\n P<\/jats:italic>\n =0.004). Guideline-concordant surgery (66%) was not associated with improved rates of major morbidity (12.9% vs. 18.8%,\n P<\/jats:italic>\n =0.387), mortality (1.6% vs. 1.6%,\n P<\/jats:italic>\n >0.999), or pain relief (75.3% vs. 66.7%,\n P<\/jats:italic>\n =0.468). Outcomes were also comparable between drainage\/parenchyma-preserving surgery and formal pancreatectomy. Survey findings confirmed practice variation, including the use of formal and V-shaped pancreatectomy for small duct disease.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/sla.0000000000007202","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:00:16Z","timestamp":1788494416000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines"],"prefix":"10.1097","author":[{"given":"Charlotte L.","family":"Van Veldhuisen","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-4214","authenticated-orcid":false,"given":"Charlotte A.","family":"Leseman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleur E.M.","family":"De Rijk","sequence":"additional","affiliation":[{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"},{"name":"Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana C.","family":"Marques-Antunes","sequence":"additional","affiliation":[{"name":"Department of Surgery, ULSEDV, Santa Maria da Feira, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ausania","sequence":"additional","affiliation":[{"name":"Santiago de Compostela and Barbanza Healthcare Area - Foundation Health Research Institute of Santiago de Compostela (IDIS), Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orlin","family":"Belyaev","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Berrevoet","sequence":"additional","affiliation":[{"name":"Department for General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marja","family":"Boermeester","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Boggi","sequence":"additional","affiliation":[{"name":"Division of General and Transplant Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan A.","family":"Bouwense","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands"},{"name":"Institute of Nutrition and Translational Research in Metabolism (NUTRIM)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco J.","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier R.","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Conlon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safi","family":"Dokmak","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Universit\u00e9 de Paris Cit\u00e9. Centre de Recherche sur l\u2019Inflammation, INSERM Unit\u00e9 Mixte de Recherche 1149, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Falconi","sequence":"additional","affiliation":[{"name":"Pancreatic and Transplant Surgical Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Universit\u00e0 Vita-Salute, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poya","family":"Ghorbani","sequence":"additional","affiliation":[{"name":"Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Gryspeerdt","sequence":"additional","affiliation":[{"name":"Department for General and HPB Surgery and Liver Transplantations, Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roel","family":"Haen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturan","family":"Ibrahimli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Liv Bona Dea Hospital, Baku, Azerbaijan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob R.","family":"Izbicki","sequence":"additional","affiliation":[{"name":"Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Krikke","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arto","family":"Kokkola","sequence":"additional","affiliation":[{"name":"Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lancelot","family":"Marique","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Universit\u00e9 de Paris Cit\u00e9. Centre de Recherche sur l\u2019Inflammation, INSERM Unit\u00e9 Mixte de Recherche 1149, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.S.D.","family":"Mieog","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Nappo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Milan, Italy"},{"name":"Pancreatic Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis","family":"Pavulans","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haralds","family":"Plaudis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga East Clinical University Hospital, Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Roeyen","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Transplantation and Endocrine Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Scognamiglio","sequence":"additional","affiliation":[{"name":"Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Tamburrino","sequence":"additional","affiliation":[{"name":"Pancreatic and Transplant Surgical Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Universit\u00e0 Vita-Salute, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tore","family":"Tholfsen","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Toschka","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faik G.","family":"Uzunoglu","sequence":"additional","affiliation":[{"name":"Department for General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Van Dieren","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper H.J.","family":"Van Eijck","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanin E.","family":"van Hooft","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hjalmar C.","family":"Van Santvoort","sequence":"additional","affiliation":[{"name":"Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands"},{"name":"Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Verdonk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier P.","family":"Voermans","sequence":"additional","affiliation":[{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"},{"name":"Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Waage","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Dutch Pancreatitis Study Group (DSPG) and the Scientific and Research Committee of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,4]]},"container-title":["Annals of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/SLA.0000000000007202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:00:16Z","timestamp":1788494416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/SLA.0000000000007202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1097\/sla.0000000000007202","relation":{},"ISSN":["0003-4932","1528-1140"],"issn-type":[{"value":"0003-4932","type":"print"},{"value":"1528-1140","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"assertion":[{"value":"2026-02-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}