Disease duration before surgical resection for chronic pancreatitis impacts long-term outcome

Abstract

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment. All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed. A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0–35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI ( P = .02; OR .88; 95%CI .80–98). An endocrine insufficiency was a negative prognostic factor for SCI ( P = .01; OR .15; 95%CI .04–68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale. The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.

The Impact of Pancreatic Head Resection on Blood Glucose Homeostasis in Patients with Chronic Pancreatitis

“…While conservative and endoscopic treatment options exist, surgical treatment is significantly more cost-effective and, especially with regard to pain relief, superior to non-surgical management of CP [17]. A retrospective analysis of the CP cohort treated at our hospital underlines that surgical therapy should be considered at early disease stages [18]. Moreover, the randomized ESCAPE trial published in 2020 as well as a recent publication by Cahen et al demonstrate the superiority of early surgical therapy on patients with CP [19,20].…”

Unifying the Hepatopancreatobiliary Surgery Fellowship Curriculum via Delphi Consensus

“…Although patients with chronic pancreatitis are often attended by general surgery residents via supportive or IR management, surgical management of chronic pancreatitis is more appropriate for fellowship training. 23,24 Therefore, the low consensus may have stemmed from the difference between surgical and IR management.…”

Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer: Untying the Gordian knot

“…Early surgery, i.e . performed within 3 years of the onset of CP symptoms, is associated with better pain relief and preservation of pancreatic function[ 3 , 54 ]. Considering recent evidence for early surgery in CP and its potential protective role in the development of PC, the clinician faces the question of prophylactic surgery in CP patients.…”

“…Pain is the dominant symptom of CP, followed by clinical manifestations of exocrine and endocrine dysfunction[ 2 ]. Surgery and endoscopic interventions are primarily indicated in symptomatic CP patients to provide pain relief and may prevent disease progression if done early in the disease course[ 3 , 4 ]. Pancreatic ductal adenocarcinoma, the most common type of pancreatic cancer (PC), is an aggressive tumor with a dismal prognosis[ 5 ].…”