title: Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis.
abstract: OBJECTIVE
  We measured a comprehensive set of outcome measures after different surgical procedures for painful chronic pancreatitis (CP) at long-term follow-up.
  
  
  BACKGROUND
  Pain caused by CP can be alleviated through operative intervention with type of procedure depending on anatomical abnormalities. Outcome measures include functional (pain relief, quality of life [QoL]), medical (endo- and exocrine function), and clinical (reoperation) results reported by patient.
  
  
  METHODS
  A cross-sectional cohort of 223 consecutive patients who underwent surgical drainage, head resection, or left-sided pancreas resection, depending on anatomical abnormalities, was analyzed. Participating patients were reassessed during a prospectively scheduled outpatient clinic visit.
  
  
  RESULTS
  At follow-up, 44 patients had died; 146 of 179 living patients consented to participate in the study. After 63 months (range: 14-268), 68% reported no or little pain, 19% reported intermediate pain, and 12% reported severe pain. Preoperative daily opioid use (OR: 3.04; 95% confidence interval [CI]: 1.09-8.49) and high numbers of preceding endoscopic procedures (OR [odds ratio]: 3.89; 95% CI: 1.01-14.9) were associated with persistent severe pain. Compared with the general population, physical more than mental QoL remained impaired (P < 0.05). At follow-up, endocrine insufficiency was present in 57% of patients and exocrine insufficiency was present in 77%. Independently, a head resection and a reoperation for any cause were moderately associated with new-onset diabetes (P < 0.1). Compared with patients who underwent left-sided resection, the risk of developing exocrine insufficiency after surgery was higher after drainage or head resection. After 20 months (interquartile range: 10-51) after surgery, 26 (12%) of 223 patients underwent 1 or more elective reoperations.
  
  
  CONCLUSIONS
  Operative intervention for painful CP, tailored to anatomical abnormalities, results in excellent to fair long-term pain relief, but approximately 10% of patients do not respond. QoL scores remained slightly compromised. High preoperative pain levels, suggested through daily opioid use and high numbers of endoscopic procedures, are associated with less favorable outcome.
authors.affiliation: Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Niels A
authors.initials: NA
authors.lastname: van der Gaag
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Mirjam A
authors.initials: MA
authors.lastname: Sprangers
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Chantal
authors.initials: C
authors.lastname: Zevenbergen
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D004700:Endocrine System Diseases / Q000209:etiology; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D010180:Pancreatectomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid