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A Network Meta-analysis of Surgery for Chronic Pancreatitis: Impact on Pain and Quality of Life

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The surgical operation associated with improved pain and quality of life (QoL) in patients with chronic pancreatitis (CP) is unknown.

Method

The Scopus, EMBASE, Medline and Cochrane databases were systematically searched until May 2019, and all randomised trials (RCTs) comparing surgical operations for CP pain were included in a network meta-analysis (NMA).

Results

Four surgical operations for treating CP were directly compared in eight RCTs including 597 patients. Patients were mainly male (79%, 474/597) with alcoholic CP (85%, 382/452). Surgical operations included were pancreatoduodenectomy (224, 38%), Berne procedure (168, 28%), Beger procedure (133, 22%) and Frey procedure (72, 12%). The NMA revealed that the Beger procedure ranked best for pain relief, whilst the Frey procedure ranked best for postoperative QoL, postoperative pancreatic fistula rate and postoperative exocrine insufficiency rate during a median follow-up of 26 months (reported range 6–58 months). Overall the Frey procedure ranked best for the combination of primary outcome measures based on surface under cumulative ranking curve scores.

Conclusions

Overall the Frey procedure may perform the best for both pain relief and postoperative QoL in patients with CP. Further trials are warranted in defining the role of surgery in relation to endotherapy.

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Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Chathura B. B. Ratnayake, Benjamin P. T. Loveday & John A. Windsor

  2. Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery,, Freeman Hospital, Newcastle upon Tyne, UK

    Sivesh K. Kamarajah, Steve White, Jeremy J. French & Sanjay Pandanaboyana

  3. Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia

    Benjamin P. T. Loveday

  4. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Benjamin P. T. Loveday

  5. Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK

    Manu Nayar & Kofi Oppong

  6. Department of Surgery, Auckland District Health Board, Auckland, New Zealand

    Chathura B. B. Ratnayake & John A. Windsor

  7. Population Health Sciences Institute, Newcastle University, Newcastle, UK

    Sanjay Pandanaboyana

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  1. Chathura B. B. Ratnayake
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Ratnayake, C.B.B., Kamarajah, S.K., Loveday, B.P.T. et al. A Network Meta-analysis of Surgery for Chronic Pancreatitis: Impact on Pain and Quality of Life. J Gastrointest Surg 24, 2865–2873 (2020). https://doi.org/10.1007/s11605-020-04718-z

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  • DOI: https://doi.org/10.1007/s11605-020-04718-z

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