Earlier surgery improves outcomes from painful chronic pancreatitis

The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a s...

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Veröffentlicht in:	Medicine (Baltimore) Jg. 97; H. 19; S. e0651
Hauptverfasser:	Ke, Nengwen, Jia, Dan, Huang, Wei, Nunes, Quentin M., Windsor, John A., Liu, Xubao, Sutton, Robert
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved 01.05.2018 Wolters Kluwer Health
Schlagworte:	Abdominal Pain - etiology Abdominal Pain - prevention & control Calcinosis Digestive System Surgical Procedures - adverse effects Digestive System Surgical Procedures - methods Dilatation, Pathologic Female Humans Intraoperative Complications Jaundice - complications Male Middle Aged Observational Study Pancreas - pathology Pancreas - physiology Pancreatic Ducts - pathology Pancreatitis, Chronic - complications Pancreatitis, Chronic - pathology Pancreatitis, Chronic - physiopathology Pancreatitis, Chronic - surgery Postoperative Complications Time Factors
ISSN:	0025-7974, 1536-5964, 1536-5964
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Abstract	The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures.
AbstractList	The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures. The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures.The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures. The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes. Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012. The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/− ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033). Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures.
Author	Ke, Nengwen Windsor, John A. Liu, Xubao Huang, Wei Sutton, Robert Nunes, Quentin M. Jia, Dan
AuthorAffiliation	Department of Pancreatic Surgery Division of General Practice Department of Integrated Traditional Chinese and Western Medicine (WH), West China Hospital, Sichuan University, Chengdu, China NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK Department of Surgery (JAW), University of Auckland, Auckland, New Zealand
AuthorAffiliation_xml	– name: Department of Pancreatic Surgery Division of General Practice Department of Integrated Traditional Chinese and Western Medicine (WH), West China Hospital, Sichuan University, Chengdu, China NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK Department of Surgery (JAW), University of Auckland, Auckland, New Zealand – name: c Department of Integrated Traditional Chinese and Western Medicine (WH), West China Hospital, Sichuan University, Chengdu, China – name: a Department of Pancreatic Surgery – name: d NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK – name: e Department of Surgery (JAW), University of Auckland, Auckland, New Zealand – name: b Division of General Practice
Author_xml	– sequence: 1 givenname: Nengwen surname: Ke fullname: Ke, Nengwen organization: Department of Pancreatic Surgery Division of General Practice Department of Integrated Traditional Chinese and Western Medicine (WH), West China Hospital, Sichuan University, Chengdu, China NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK Department of Surgery (JAW), University of Auckland, Auckland, New Zealand – sequence: 2 givenname: Dan surname: Jia fullname: Jia, Dan – sequence: 3 givenname: Wei surname: Huang fullname: Huang, Wei – sequence: 4 givenname: Quentin surname: Nunes middlename: M. fullname: Nunes, Quentin M. – sequence: 5 givenname: John surname: Windsor middlename: A. fullname: Windsor, John A. – sequence: 6 givenname: Xubao surname: Liu fullname: Liu, Xubao – sequence: 7 givenname: Robert surname: Sutton fullname: Sutton, Robert
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Snippet	The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were... The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes. Clinical course, Izbicki pain scores, and pancreatic function were...
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SubjectTerms	Abdominal Pain - etiology Abdominal Pain - prevention & control Calcinosis Digestive System Surgical Procedures - adverse effects Digestive System Surgical Procedures - methods Dilatation, Pathologic Female Humans Intraoperative Complications Jaundice - complications Male Middle Aged Observational Study Pancreas - pathology Pancreas - physiology Pancreatic Ducts - pathology Pancreatitis, Chronic - complications Pancreatitis, Chronic - pathology Pancreatitis, Chronic - physiopathology Pancreatitis, Chronic - surgery Postoperative Complications Time Factors
Title	Earlier surgery improves outcomes from painful chronic pancreatitis
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