Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief

Arch Surg. 2012 Oct;147(10):925-32. doi: 10.1001/archsurg.2012.1094.


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.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nomograms*
  • Pain Management
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Pancreatitis, Chronic / complications*
  • Pancreatitis, Chronic / surgery*
  • Quality of Life
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult