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Arch Surg. 2012 Oct;147(10):925-32. doi: 10.1001/archsurg.2012.1094.

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

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  • 1Department of Surgery, University Medical Center, Utrecht. u.ahmedali@pancreatitis.nl

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.

PMID:
23117832
[PubMed - indexed for MEDLINE]
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