Tailored surgery in chronic pancreatitis after implementation of a multidisciplinary team assessment; a prospective observational study

Waage, Anne; Vinge-Holmqvis, Olof; Labori, Knut Jørgen; Paulsen, Vemund; Aabakken, Lars; Lenz, Harald; Magnus, Henrik Christian Felix; Tholfsen, Tore; Hauge, Truls

doi:10.1016/j.hpb.2022.09.007

Cited by 4 publications

(1 citation statement)

References 46 publications

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“…Small studies concentrated in geographic areas with sophisticated care systems for patients with CP have been designed to assess the benefits of such an approach, and preliminary data suggest improved outcomes overall. [122,123] Additional study is needed to disseminate algorithms for coordinated care in patients with painful CP. The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders, exocrine pancreatic insufficiency, mineral bone disease, frailty, and malnutrition, are likely to improve the overall health of patients with painful CP and have beneficial effects on the pain experience in this disease as well.…”

Section: Gaps In Knowledge and Paths Forwardmentioning

confidence: 99%

Recent advances in the understanding and management of chronic pancreatitis pain

Walker,

Babyok,

Saloman

et al. 2023

Journal of Pancreatology

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Abdominal pain is the most common symptom of chronic pancreatitis (CP), and is often debilitating for patients and very difficult to treat. To date, there exists no cure for the disease. Treatment strategies focus on symptom management and on mitigation of disease progression by reducing toxin exposure and avoiding recurrent inflammatory events. Traditional treatment protocols start with medical management followed by consideration of procedural or surgical intervention on selected patients with severe and persistent pain. The incorporation of adjuvant therapies to treat comorbidities including psychiatric disorders, exocrine pancreatic insufficiency, mineral bone disease, frailty, and malnutrition, are in their early stages. Recent clinical studies and animal models have been designed to improve investigation into the pathophysiology of CP pain, as well as to improve pain management. Despite the array of tools available, many therapeutic options for the management of CP pain provide incomplete relief. There still remains much to discover about the neural regulation of pancreas-related pain. In this review we will discuss research from the last five years that has provided new insights into novel methods of pain phenotyping and the pathophysiology of CP pain. These discoveries have led to improvements in patient selection for optimization of outcomes for both medical and procedural management, and identification of potential future therapies.

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Section: Gaps In Knowledge and Paths Forwardmentioning

confidence: 99%

Recent advances in the understanding and management of chronic pancreatitis pain

Walker,

Babyok,

Saloman

et al. 2023

Journal of Pancreatology

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Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach

Kawka,

Lucas,

Riad

et al. 2024

HPB

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Implementation of a nationwide program for total pancreatectomy and islet autotransplantation in chronic pancreatitis: A Scandinavian single-center observational study

Waage,

Khan,

Labori

et al. 2024

Scand J Surg

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Background: Tailoring surgical treatment is mandatory to optimize outcomes in chronic pancreatitis. Total pancreatectomy (TP) offers pain relief in a subset of patients. TP with islet autotransplantation (IAT) has the potential to reduce the burden of postsurgical diabetes. We present the first Scandinavian prospective study assessing outcomes following total pancreatectomy and islet autotransplantation (TPIAT) in chronic pancreatitis. Our aim was to assess short- and long-term outcomes following implementation of a nationwide program of TPIAT at a tertiary reference center for pancreatic surgery in Norway. Methods: A prospective, observational single-center study enrolling consecutive patients undergoing TPIAT for chronic pancreatitis at Oslo University Hospital. The selection of potential candidates for TPIAT was based on discussions at multidisciplinary team (MDT) meetings, focusing on tailored surgery in chronic pancreatitis. Patients were finally evaluated in a dedicated TPIAT team. The outcome measures included pain relief, quality of life (QoL) assessed by EORTC QLQ-C30, complications, and glycemic control. Results: Between August 2017 and November 2022, 15 patients underwent TPIAT. The follow-up rate was 87% with a median follow-up of 26 months (range = 14–65). Pain relief was achieved in 92%. EORTC QLQ-C30 analysis revealed clinically significant improvements in 28 of 30 domains, particularly in pain and role- and social-functioning. The Clavien-Dindo ≥IIIa complications occurred in one patient. There was no 90 days mortality. All patients maintained C-peptide positivity, although none of the patients reached insulin independence. Conclusion: TPIAT was as a safe and effective treatment for a selected group of patients with chronic pancreatitis, providing substantial pain relief and enhanced QoL. Islet autotransplantation prevented complete insulin deficiency, reducing diabetes severity postpancreatectomy. Dedicated chronic pancreatitis MDT meetings were key factor in the success of the program.

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Tailored surgery in chronic pancreatitis after implementation of a multidisciplinary team assessment; a prospective observational study

Cited by 4 publications

References 46 publications

Recent advances in the understanding and management of chronic pancreatitis pain

Recent advances in the understanding and management of chronic pancreatitis pain

Quality of life instruments in acute and chronic pancreatitis: a consensus-based standards for the selection of health measurement instruments (COSMIN) approach

Implementation of a nationwide program for total pancreatectomy and islet autotransplantation in chronic pancreatitis: A Scandinavian single-center observational study

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