Skip to main content
SpringerLink
Log in

Systematic Review of Early Surgery for Chronic Pancreatitis: Impact on Pain, Pancreatic Function, and Re-intervention

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

Abstract

Background

Surgical intervention has traditionally been reserved as the last management option for pain in chronic pancreatitis. Recently, there has been a call for surgery to be offered earlier in the disease process. The objectives of this review were to evaluate the effect of early surgery on postoperative pain, pancreatic function, and re-intervention rates in chronic pancreatitis.

Methods

A systematic literature search through EMBASE, Cochrane Review, and PubMed from January 1950 to January 2014 was conducted. Citations found in relevant papers are hand-searched. Data which could be pooled were analyzed using Revman (v5.2). Risk of bias analysis was conducted.

Results

Of the 2,886 potentially eligible studies identified, 11 studies met the inclusion criteria. There was large heterogeneity in the study designs, and studies were conducted over a lengthy time span. Seven studies examined pain, three studies examined pancreatic function, and three studies examined rates of re-intervention. Meta-analysis of the three studies with comparative raw data regarding complete pain relief showed that early surgery was associated with an increased likelihood of complete postoperative pain relief (RR = 1.67, 95 % CI 1.09–2.56, p = 0.02). Early surgery was also associated with reduced risk of pancreatic insufficiency and low re-intervention rates.

Conclusions

Data from this study supports considering early surgery for pain management in patients with chronic pancreatitis, with the potential of a reduced risk of pancreatic insufficiency and the need for further intervention. Further prospective randomized studies are warranted comparing early surgery against conservative step-up approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. van der Gaag NA, van Gulik TM, Busch OR, Sprangers MA, Bruno MJ, Zevenbergen C, et al. Functional and medical outcomes after tailored surgery for pain due to chronic pancreatitis. Ann Surg 2012; 255(4):763-70.

    Article  PubMed  Google Scholar 

  2. Issa Y, van Santvoort HC, van Goor H, Cahen DL, Bruno MJ, Boermeester MA. Surgical and endoscopic treatment of pain in chronic pancreatitis: a multidisciplinary update. Dig Surg 2013; 30(1):35-50.

    Article  PubMed  CAS  Google Scholar 

  3. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 2010; 251(1):18-32.

    Article  PubMed  Google Scholar 

  4. Hartel M, Tempia-Caliera AA, Wente MN, Z'graggen K, Friess H, Buchler MW. Evidence-based surgery in chronic pancreatitis. Langenbecks Arch Surg 2003; 388(2):132-9.

    PubMed  Google Scholar 

  5. Fregni F, Lenkinski R, Freedman SD, and Pascual-Leone A. Clinical effects and brain metabolic correlates in noninvasive cortical neuromodulation for visceral pain. European Journal of Pain 2011; 15:53-60.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Deviere J, Bell RH, Beger HG, Traverso LW. Treatment of chronic pancreatitis with endotherapy or surgery: critical review of randomized control trials. J Gastrointest Surg 2008; 12(4):640-4.

    Article  PubMed  Google Scholar 

  7. Tiscornia OM, Dreiling DA. Recovery of pancreatic exocrine secretory capacity following prolonged ductal obstruction. Bicarbonate and amylase response to hormonal stimulation. Ann Surg. 1966;164(2):267-70.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Lamme B, Boermeester MA, Straatsburg IH, van Buijtenen JM, Boerma D, Offerhaus GJA, et al. Early versus late surgical drainage for obstructive pancreatitis in an experimental model. Br J Surg 2007; 94;849-854.

    Article  PubMed  CAS  Google Scholar 

  9. Nealon WH, Thompson JC. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified puestow procedure. Ann Surg 1993; 217(5): 458–468.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Ihse I, Borch K, Larsson J. Chronic pancreatitis: results of operations for relief of pain. World J Surg 1990;14(1):53-8.

    Article  PubMed  CAS  Google Scholar 

  11. American Gastroenterological Association. American Gastroenterological Association medical position statement: treatment of pain in chronic pancreatitis. Gastroenterology 1998; 115(3):763-764.

    Article  Google Scholar 

  12. Bachmann K, Izbicki JR, Yekebas EF. Chronic pancreatitis: modern surgical management. Langenbecks Arch Surg 2011; 396(2):139-49.

    Article  PubMed  Google Scholar 

  13. Mannell A, Adson MA, McIlrath DC, Ilstrup DM. Surgical management of chronic pancreatitis: long-term results in 141 patients. Br J Surg 1988;75(5):467-72.

    Article  PubMed  CAS  Google Scholar 

  14. Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003; 35(7):553-8.

    Article  PubMed  CAS  Google Scholar 

  15. Maartense S, Ledeboer M, Bemelman WA, Ringers J, Frolich M, Masclee AA. Effect of surgery for chronic pancreatitis on pancreatic function: pancreatico-jejunostomy and duodenum-preserving resection of the head of the pancreas. Surgery 2004;135(2):125-30.

    Article  PubMed  Google Scholar 

  16. Alexakis N, Connor S, Ghaneh P, Raraty M, Lombard M, Smart H, Evans J, Hughes M, Garvey CJ, Goulden M, Parker C, Sutton R, Neoptolemos JP. Influence of opioid use on surgical and long-term outcome after resection for chronic pancreatitis. Surgery 2004;136(3):600-8.

    Article  PubMed  CAS  Google Scholar 

  17. Riediger H, Adam U, Fischer E, Keck T, Pfeffer F, Hopt UT, Makowiec F.Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007;11(8):949-59.

    Article  PubMed  Google Scholar 

  18. Rutter K, Ferlitsch A, Sautner T, Püspök A, Gotzinger P, Gangl A, et al. Hospitalization, frequency of interventions, and quality of life after endoscopic, surgical, or conservative treatment in patients with chronic pancreatitis. World J Surg 2010;34(11):2642-7.

    Article  PubMed  Google Scholar 

  19. Cahen DL, Gouma DJ, Laramee P, Nio Y, Rauws EA, Boermeester MA, et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 2011;141(5):1690-5.

    Article  PubMed  Google Scholar 

  20. Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH, Gooszen HG, van Dam RM, Busch OR, Dijkgraaf MG, Mauritz FA, Jens S, Mast J, van Goor H, Boermeester MA; Dutch Pancreatitis Study Group. Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg 2012;147(10):925-32.

    PubMed  Google Scholar 

  21. Clarke B, Slivka A, Tomizawa Y, Sanders M, Papachristou GI, Whitcomb DC, Yadav D. Endoscopic therapy is effective for patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2012;10(7):795-802.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Negi S, Singh A, Chaudhary A. Pain relief after Frey's procedure for chronic pancreatitis. Br J Surg 2010;97(7):1087-95.

    Article  PubMed  CAS  Google Scholar 

  23. Cahen DL, Gouma DJ, Nio Y, Rauws EAJ, Boermeester MA, Busch OR, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007; 356:676-684

    Article  PubMed  CAS  Google Scholar 

  24. Seven G, Schreiner MA, Ross AS, Lin OS, Gluck M, Gan SI, et al. Long-term outcomes associated with pancreatic extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2012;75(5):997-1004.

    Article  PubMed  Google Scholar 

  25. Dumonceau JM, Devière J, Le Moine O, Delhaye M, Vandermeeren A, Baize M, Van Gansbeke D, Cremer M. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results. Gastrointest Endosc 1996;43(6):547-55.

    Article  PubMed  CAS  Google Scholar 

  26. Beger HG, Schlosser W, Friess H, Büchler MW. Duodenum-Preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Annals of Surgery 1999; 230(4):512

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Farkas G, Leindler L, Daroczi M, Farkas G. Long-term Follow-up after organ-preserving pancreatic head resection in patients with chronic pancreatitis. J Gastrointest Surg 2008; 12:308–312.

    Article  PubMed  Google Scholar 

  28. Frey C, Anderson D. Surgery of chronic pancreatitis. American Journal of Surgery 2007; 194: S53–S60.

    Article  Google Scholar 

  29. Tiscornia OM, Dreiling DA. Recovery of Pancreatic exocrine secretory capacity following prolonged ductal obstruction. Annals of Surgery 1966; 164: 267-270.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Michalski CW, Shi X, Reiser C, Fachinger P, Zimmermann A, Buchler MW, et al. Neurokinin-2 receptor levels correlate with intensity, frequency, and duration of pain in chronic pancreatitis. Ann Surg. 2007 Nov;246(5):786-93.

  31. Chinnakotla S, Bellin MD, Schwarzenberg SJ, Radosevich DM, Cook M, Dunn TB, et al. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes. Ann Surg 2014 [Epub ahead of print]

  32. Kobayashi T, Manivel JC, Bellin MD, Carlson AM, Moran A, Freeman ML, et al. Correlation of pancreatic histopathologic findings and islet yield in children with chronic pancreatitis undergoing total pancreatectomy and islet autotransplantation. Pancreas 2010;39:57–63.

    Article  PubMed  Google Scholar 

  33. Wang H. Desai KD. Dong H. Owzarski S. Romagnuolo J. Morgan KA. Adams DB. Prior surgery determines islet yield and insulin requirement in patients with chronic pancreatitis. Transplantation 2013; 95(8):1051-7

    Article  PubMed  CAS  Google Scholar 

  34. Morgan KA, Theruvath T, Owczarski S, Adams DB. Total pancreatectomy with islet autotransplantation for chronic pancreatitis: do patients with prior pancreatic surgery have different outcomes? The American Surgeon 2012; 78(8): 893-6.

    PubMed  Google Scholar 

Download references

Funding

Catherine Yang received a fund from Fulbright New Zealand Scholarship, Lindsay Bliss was funded by the Pyrtek Fund Research Scholarship, and Jennifer Tseng was funded by Howard Hughes Medical Institute Early Career Grant.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Stoneman 9, Boston, MA, USA

    Catherine J. Yang, Lindsay A. Bliss, Emily F. Schapira, Sing Chau Ng & Jennifer F. Tseng

  2. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Steven D. Freedman

  3. Department of Surgery, The University of Auckland, Auckland, New Zealand

    Catherine J. Yang & John A. Windsor

Authors
  1. Catherine J. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lindsay A. Bliss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily F. Schapira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven D. Freedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sing Chau Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John A. Windsor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jennifer F. Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer F. Tseng.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, C.J., Bliss, L.A., Schapira, E.F. et al. Systematic Review of Early Surgery for Chronic Pancreatitis: Impact on Pain, Pancreatic Function, and Re-intervention. J Gastrointest Surg 18, 1863–1869 (2014). https://doi.org/10.1007/s11605-014-2571-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2571-8

Keywords

Search

Navigation