Tailoring management of benign and premalignant pancreatic diseases

This thesis examines key aspects of the management of benign and premalignant pancreatic diseases. The first part focuses on optimizing the surgical management of chronic pancreatitis, evaluating the use and outcomes of morphology-based surgery and assessing adherence to current international guidelines across Europe (Chapters 1–3). The second part addresses the management of intraductal papillary mucinous neoplasm (IPMN), with a particular focus on improving patient selection for surgery by incorporating the risks associated with different types of pancreatic resection, developing tools for preoperative risk prediction, and evaluating the diagnostic value of serum CA19.9. In addition, the protocol of the TRIVIAL study is presented, which investigates whether surveillance can safely be discontinued in patients with low-risk branch-duct IPMN after five years of stability (Chapters 4–7). The third part focuses on the management of diabetes following total pancreatectomy and describes the rationale, design, and results of the PANORAMA trial, evaluating a bihormonal artificial pancreas for improving glycemic control and quality of life in this patient population (Chapters 8–9). Together, the studies presented in this thesis contribute to a more tailored approach to the management of benign and premalignant pancreatic diseases, aiming to optimize treatment selection while minimizing unnecessary intervention and treatment-related burden.