Markers of severe fibrosis in chronic pancreatitis and long-term postoperative outcomes in patients with chronic pancreatitis

Objective. To analyze the markers of severe pancreatic fibrosis and long-term results of open Frey procedure and distal pancreatectomy for chronic pancreatitis depending on morphological changes. Material and methods. Twenty-four patients with chronic pancreatitis, post-necrotic cysts and calcinates in parenchyma and/or ductal system, as well as pancreatic duct enlargement underwent Frey procedure (19) and distal pancreatectomy (5) between June 2020 and June 2024. Pain syndrome before and after surgery was assessed using visual analog scale, exocrine insufficiency — considering severity of diarrhea and body mass index, endocrine insufficiency — blood glucose. All patients underwent contrast-enhanced CT of the abdomen, 50% — MR pancreatography. After surgery, morphological analysis of pancreatic tissue was conducted. Long-term outcomes were compared with preoperative CT data and morphological features of pancreatic tissue. Results. When comparing morphological features of pancreatic tissue after surgery with preoperative CT data, we found that markers of severe fibrosis were multiple calcinates (>5 five) in organ tissue and ducts (r=0.71; p=0.00), signs of pancreatic atrophy (r=0.67; p=0.00), increased diameter of the main pancreatic duct (r=0.54; p=0.00). More severe pancreatic fibrosis was accompanied by more significant changes of acinuses and islets of Langerhans (r=0.85; p=0.00), as well as higher blood glucose (r=0.41; p=0.04). Long history of disease (> 37 months) positively correlated with severity of pancreatic fibrosis (r=0.68; p=0.00). Pain relief in long-term period after Frey procedure did not depend on severity of fibrosis, but diabetes and impaired exocrine function correlated with fibrosis (r=0.85; p=0.00). Conclusion. Markers of severe pancreatic fibrosis are duration of disease and number of typical CT changes (amount of calcinates, signs of pancreatic atrophy, dilation of the main pancreatic duct). Frey procedure and distal pancreatectomy in patients with chronic pancreatitis and pain syndrome can reduce its intensity in long-term period, stabilize exocrine and endocrine functions of the pancreas. Pain relief did not depend on severity of fibrosis diagnosed by CT and verified by morphological examination of pancreatic tissue.