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Earlier surgery improves outcomes from painful chronic pancreatitis.

Abstract The timing of surgery for painful chronic pancreatitis (CP) may affect outcomes.Clinical course, Izbicki pain scores, and pancreatic function were retrospectively compared and analyzed between patients undergoing either early or late surgery (< 3 or ≥ 3 years from diagnosis) for painful CP in a single center from 2007 to 2012.The early surgery group (n = 98) more frequently than the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P = .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P < .001), but less frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation alone (31% vs 71%, P < .001), parenchymal calcification (91.8% vs 100%, P < .001) or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant differences. The early group had longer hospital stay (14.4 vs 12.2 days, P = .009), but no difference in complications. Significantly greater pain relief followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results in higher rates of pain relief and pancreatic sufficiency than late surgery for chronic pancreatitis patients. Frey and Berne procedures showed better results than other surgical procedures.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29742705
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Earlier surgery improves outcomes from painful chronic pancreatitis.
PG  - e0651
LID - 10.1097/MD.0000000000010651 [doi]
AB  - The timing of surgery for painful chronic pancreatitis (CP) may affect
      outcomes.Clinical course, Izbicki pain scores, and pancreatic function were
      retrospectively compared and analyzed between patients undergoing either early or
      late surgery (&lt; 3 or &gt;/= 3 years from diagnosis) for painful CP in a single
      center from 2007 to 2012.The early surgery group (n = 98) more frequently than
      the late group (n = 199) had abdominal pain with jaundice (22.4% vs 9.5%, P =
      .002) and pancreatic mass +/- ductal dilatation (47% vs 27%, P &lt; .001), but less 
      frequently abdominal pain alone (73.5% vs 85.9%, P = .009), ductal dilatation
      alone (31% vs 71%, P &lt; .001), parenchymal calcification (91.8% vs 100%, P &lt; .001)
      or exocrine insufficiency (60% vs 72%, P = .034); there were no other significant
      differences. The early group had longer hospital stay (14.4 vs 12.2 days, P =
      .009), but no difference in complications. Significantly greater pain relief
      followed early surgery (complete 69% vs 47%, partial 22% vs 37%, none 8% vs 16%, 
      P = .01) with lower rates of exocrine (60% vs 80%, P = .005) and endocrine
      insufficiency (36% vs 53%, P = .033).Our data indicate that early surgery results
      in higher rates of pain relief and pancreatic sufficiency than late surgery for
      chronic pancreatitis patients. Frey and Berne procedures showed better results
      than other surgical procedures.
FAU - Ke, Nengwen
AU  - Ke N
AD  - Department of Pancreatic Surgery.
FAU - Jia, Dan
AU  - Jia D
AD  - Division of General Practice.
FAU - Huang, Wei
AU  - Huang W
AD  - Department of Integrated Traditional Chinese and Western Medicine (WH), West
      China Hospital, Sichuan University, Chengdu, China.
FAU - Nunes, Quentin M
AU  - Nunes QM
AD  - NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University
      Hospital, University of Liverpool, Liverpool, UK.
FAU - Windsor, John A
AU  - Windsor JA
AD  - Department of Surgery (JAW), University of Auckland, Auckland, New Zealand.
FAU - Liu, Xubao
AU  - Liu X
AD  - Department of Pancreatic Surgery.
FAU - Sutton, Robert
AU  - Sutton R
AD  - NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University
      Hospital, University of Liverpool, Liverpool, UK.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Abdominal Pain/etiology/*prevention &amp; control
MH  - Calcinosis
MH  - Digestive System Surgical Procedures/adverse effects/methods
MH  - Dilatation, Pathologic
MH  - Female
MH  - Humans
MH  - Intraoperative Complications
MH  - Jaundice/complications
MH  - Male
MH  - Middle Aged
MH  - Pancreas/pathology/physiology
MH  - Pancreatic Ducts/pathology
MH  - Pancreatitis, Chronic/complications/pathology/physiopathology/*surgery
MH  - Postoperative Complications
MH  - Time Factors
EDAT- 2018/05/10 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1097/MD.0000000000010651 [doi]
AID - 00005792-201805110-00024 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0651. doi: 10.1097/MD.0000000000010651.