RT Journal
A1 Ali U, Nieuwenhuijs VB, van Eijck CH, et al
T1 Clinical outcome in relation to timing of surgery in chronic pancreatitis: A nomogram to predict pain relief
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD October 1
VO 147
IS 10
SP 925
OP 932
DO 10.1001/archsurg.2012.1094
UL http://dx.doi.org/10.1001/archsurg.2012.1094
AB 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.