title: Insulin dependence and pancreatic enzyme replacement therapy are independent prognostic factors for long-term survival after operation for chronic pancreatitis.
abstract: BACKGROUND
  This retrospective, single-center, observational study on postoperative long-term results aims to define yet unknown factors for long-term outcome after operation for chronic pancreatitis.
  
  
  METHODS
  We analyzed 147 consecutive patients operated for chronic pancreatitis from 2000 to 2011. Mean follow-up was 5.3 years (range, 1 month to 12.7 years). Complete long-term survival data were provided by the German citizen registration authorities for all patients. A quality-of-life questionnaire was sent to surviving patients after a mean follow-up of 5.7 years.
  
  
  RESULTS
  Surgical principles were resection (n = 86; 59%), decompression (n = 29; 20%), and hybrid procedures (n = 32; 21%). No significant influences of different surgical principles and operative procedures on survival, long-term quality of life and pain control could be detected. Overall 30-day mortality was 2.7%, 1-year survival 95.9%, and 3-year survival 90.8%. Multivariate Cox regression analysis revealed that only postoperative insulin dependence at the time of hospital discharge (P = .027; Exp(B) = 2.111; 95% confidence interval [CI], 1.089-4.090) and the absence of pancreas enzyme replacement therapy at the time of hospital discharge (P = .039; Exp(B) = 2.102; 95% CI, 1.037-4.262) were significant, independent risk factors for survival with significant hazard ratios for long-term survival. Long-term improvement in quality of life was reported by 55 of 76 long-term survivors (73%).
  
  
  CONCLUSIONS
  Pancreatic enzyme replacement should be standard treatment after surgery for chronic pancreatitis at the time of hospital discharge, even when no clinical signs of exocrine pancreatic failure exist. This study underlines the potential importance of early operative intervention in chronic pancreatitis before irreversible endocrine dysfunction is present.
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Winny
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Vagia
authors.initials: V
authors.lastname: Paroglou
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Bektas
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany; Federal Armed Forces Medical Center Hannover, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany; Department of General and Thoracic Surgery, Universitätsklinikum Schleswig Holstein, Kiel, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Reichert
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Lea
authors.initials: L
authors.lastname: Zachau
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Kleine
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.affiliation: General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany. Electronic address: schrem.harald@mh-hannover.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D056947:Enzyme Replacement Therapy; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult