• Usama Ahmed Ali, Vincent B Nieuwenhuijs, Casper H van Eijck, Hein G Gooszen, Ronald M van Dam, Olivier R Busch, Marcel G W Dijkgraaf, Femke A Mauritz, Sjoerd Jens, Jay Mast, Harry van Goor, Marja A Boermeester, and Dutch Pancreatitis Study Group.
• Department of Surgery, University Medical Center, Utrecht. u.ahmedali@pancreatitis.nl
• Arch Surg. 2012 Oct 1; 147 (10): 925-32.

ObjectiveTo evaluate the effect of timing of surgery on the long-term clinical outcome of surgery in chronic pancreatitis (CP).DesignCohort study with long-term follow-up.SettingFive specialized academic centers.PatientsPatients with CP treated surgically for pain.InterventionsPancreatic resection and drainage procedures for pain relief.Main Outcome MeasuresPain relief (pain visual analogue score ≤4), pancreatic function, and quality of life.ResultsWe 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.ConclusionsThe 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.

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