Clinical Outcome in Relation to Timing of Surgery in Chronic Pancreatitis

Ali, Usama Ahmed; Nieuwenhuijs, Vincent B.; Eijck, Casper H. van; Gooszen, Hein G.; Dam, Ronald M. van; Busch, Olivier R.; Dijkgraaf, Marcel G. W.; Mauritz, Femke A.; Jens, Sjoerd; Mast, Jay; Goor, Harry van; Boermeester, Marja A.; Group, for the Dutch Pancreatitis Study

doi:10.1001/archsurg.2012.1094

Cited by 80 publications

(87 citation statements)

References 38 publications

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“…Negi et al [87] conclude that patients should be referred for surgery before opiates are needed to relieve pain. These results are confirmed by Ahmed Ali et al [141], who found that duration of pain (>3 year), the number of endoscopic interventions (>5), and preoperative daily opioid use are independently associated with persistent severe pain after pancreatic surgery. Interestingly, this also applies for endoscopic treatment.…”

Section: Future Challenges: Timing Of Surgerysupporting

confidence: 72%

“…Furthermore, tolerance, dependency, and adverse events are frequently reported drawbacks of opioid use and have a large impact on the quality of life and social functioning [140]. Likewise, several recent studies have shown that preoperative opioid use predisposes to failure of achieving complete long-term relief of pain after endoscopic and surgical intervention [21,46,87,141,142,143]. Negi et al [87] conclude that patients should be referred for surgery before opiates are needed to relieve pain.…”

Section: Future Challenges: Timing Of Surgerymentioning

confidence: 99%

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Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

et al. 2013

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Chronic pancreatitis is an inflammatory disease of the pancreas with abdominal pain as the most prominent symptom. Adequate treatment of patients with chronic pancreatitis remains a major challenge, mainly because of the lack of evidence-based treatment protocols. The primary goal of treatment is to achieve long-term pain relief, control of the complications associated with the disease, and to restore the quality of life. Currently, a conservative step-up approach is often used for the treatment of pain; progression to severe and intractable pain is considered necessary before invasive treatment is considered. Recent studies, however, suggest that surgical intervention should not be considered only as last-resort treatment, since it can mitigate disease progression, achieve excellent pain control, and preserve pancreatic function. In this review, we present a state-of-the art overview of endoscopic and surgical treatment options for patients with painful chronic pancreatitis, and elaborate on the timing of surgery.

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Section: Future Challenges: Timing Of Surgerysupporting

confidence: 72%

Section: Future Challenges: Timing Of Surgerymentioning

confidence: 99%

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

et al. 2013

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“…A series on surgical treatment in chronic pancreatitis shows excellent long-term results [30]. The optimal timing of surgery, however, continues to be a point of debate [3, 4]. Whereas previously surgeons tried to hold off surgery until all medical and endoscopic options were exhausted, more recently others advocate early surgery because of its suggested superiority in treating pain.…”

Section: Step-up Approach For the Treatment Of Chronic Pancreatitis Painmentioning

confidence: 99%

“…Recently, multiple studies have suggested that early surgery is superior in providing pain relief and improvement of quality of life, compared to the step-up approach in which medical therapy is followed by endoscopy and finally surgery [4-6]. Delaying invasive treatment such as surgery was negatively associated in an observational study, with the duration of pre-operative opioid use, multiple endoscopic interventions and the duration of chronic pancreatitis [4].…”

Section: Timing Of Surgery In Chronic Pancreatitismentioning

confidence: 99%

“…Sometimes as a last resort, surgical drainage and/or resection procedures are proposed in the case endoscopy fails. In the recent years increasing evidence tested the step-up approach, and multiple studies suggest the superiority of surgery compared to conservative and endoscopic measures [4-6]. This article describes the indications and different surgical procedures in chronic pancreatitis and puts focus on the timing of surgery in relation to other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

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Surgery in Chronic Pancreatitis: Indication, Timing and Procedures

et al. 2019

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Chronic pancreatitis is a chronic inflammation of the pancreas with pain as its severest symptom and often an impaired quality of life. Surgical intervention plays an important role in the management of pain but is generally kept as a last resort when conservative measures and endoscopy have failed. However, in the last few years multiple studies suggested the superiority of (early) surgical treatment in chronic pancreatitis for multiple end points, including pain relief. In this paper we highlight the most recent high-quality evidence on surgical therapy in chronic pancreatitis and the rationale for early (surgical) intervention.

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Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis

Issa

Kempeneers

Bruno

et al. 2020

JAMA

Self Cite

184

162

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; for the Dutch Pancreatitis Study Group IMPORTANCE For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. OBJECTIVE To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for Յ2 months or weak opioids for Յ6 months) were included. The 18-month follow-up period ended in March 2018. INTERVENTIONS There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. MAIN OUTCOMES AND MEASURES The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. RESULTS Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, −12 points [95% CI, −22 to −2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. CONCLUSIONS AND RELEVANCE Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings.

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Clinical Outcome in Relation to Timing of Surgery in Chronic Pancreatitis

Abstract: To evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP).

Cited by 80 publications

References 38 publications

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

Surgery in Chronic Pancreatitis: Indication, Timing and Procedures

Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis

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