Clinical Outcome in Relation to Timing of Surgery in Chronic Pancreatitis A Nomogram to Predict Pain Relief

UA Ali, VB Nieuwenhuijs, Casper van Eijck, HG Gooszen, RM van Dam, OR Busch, MGW Dijkgraaf, FA Mauritz, S Jens, J (Jay) van der Mast, H van Goor, MA Boermeester

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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 reli 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 languageUndefined/Unknown
Pages (from-to)925-932
Number of pages8
JournalArchives of Surgery
Volume147
Issue number10
DOIs
Publication statusPublished - 2012

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