Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief

U. Ahmed Ali, V.B. Nieuwenhuijs, C.H. van Eijck, H.G. Gooszen, R.M. van Dam, O.R. Busch, M.G. Dijkgraaf, F.A. Mauritz, S. Jens, J. Mast, H. van Goor, M.A. Boermeester, A.A. Dutch Pancreatitis Study Group (incl. Masclee)

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Abstract

OBJECTIVE: To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP). DESIGN: Cohort study with long-term follow-up. SETTING: Five specialized academic centers. PATIENTS: Patients with CP treated surgically for pain. INTERVENTIONS: Pancreatic resection and drainage procedures for pain relief. MAIN OUTCOME MEASURES: Pain relief (pain visual analogue score </=4), pancreatic function, and quality of life. RESULTS: We included 266 patients with median follow-up of 62 months (interquartile range, 31-112). Results were presented as odds ratios (ORs)with 95% confidence intervals after correction for bias using bootstrap-corrected analysis. Pain relief was achieved in 149 patients (58%). Surgery within 3 years of symptoms was independently associated with more pain relief (OR, 1.8; 95% CI, 1.0-3.4; P = .03) and less endocrine pancreatic insufficiency (OR, 0.57; 95% CI, 0.33-0.96; P = .04). More pain relief was also observed in patients not taking opioids preoperatively (OR, 2.1; 95% CI, 1.2-4.0; P = .006) and who had 5 or fewer endoscopic treatments prior to surgery (OR, 2.5; 95% CI, 1.1-6.3; P = .04). The probability of achieving pain relief varied between 23% and 75%, depending on these risk factors. CONCLUSIONS: The timing of surgery is an important risk factor for clinical outcome in CP. Surgery may need to be considered at an earlier phase than it is now, preferably within 3 years of symptomatic CP. Likelihood of postoperative pain relief can be calculated on an individual basis using the presented nomogram.
Original languageEnglish
Pages (from-to)925-932
Number of pages8
JournalArchives of Surgery
Volume147
Issue number10
DOIs
Publication statusPublished - Oct 2012

Keywords

  • ALCOHOLIC CHRONIC-PANCREATITIS
  • MODIFIED PUESTOW PROCEDURE
  • OPERATIVE MANAGEMENT
  • SURGICAL DRAINAGE
  • NATURAL COURSE
  • PROGNOSIS
  • DUCT
  • HYPERALGESIA
  • MULTICENTER
  • RESECTION

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