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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Published in:Medicine (Baltimore) Vol. 97; no. 19; p. e0651
Main Authors: Ke, Nengwen, Jia, Dan, Huang, Wei, Nunes, Quentin M., Windsor, John A., Liu, Xubao, Sutton, Robert
Format: Journal Article
Language:English
Published: United States The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved 01.05.2018
Wolters Kluwer Health
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:0025-7974
1536-5964
1536-5964
DOI:10.1097/MD.0000000000010651