Assessment of functional outcome of patients undergoing surgery for chronic pancreatitis: A prospective study

Abstract

Backgrounds/Aims: This study was done with the aim of assessing impact of surgery for chronic pancreatitis on exocrine and endocrine functions, quality of life and pain relief of patients. Methods: 35 patients of chronic pancreatitis who underwent surgery were included. Exocrine function assessed with fecal fat globule estimation and endocrine function assessed with glycated haemoglobin (HbA1C), fasting plasma glucose (FPG), Insulin and C-peptide levels. Percentage (%) beta cell function by homeostatic model assessment (HOMA) was determined using web-based calculator. Quality of life (QOL) and pain assessment was done using Short form survey (SF-36) questionnaire and Izbicki scores respectively. Follow up done till 3 months following surgery. Results: Endocrine insufficiency was noted in 13 (37%) patients in the postoperative period compared to 17 (49%) patients preoperatively (p=0.74). Exocrine insufficiency was detected in 11 (32%) patients postoperatively compared to 8 (23%) patients preoperatively, with denovo insufficiency noted in 3 (8%) patients (p＜0.05). The mean Izbicki score at 3 months postoperatively was remarkably lower compared to preoperative score (29.3±14.3 vs. 60.6±12.06; p＜0.05). QOL at 3 months following surgery for chronic pancreatitis was significantly better than preoperative QOL (50.24±22.16 vs. 69.48±20.81; p＜0.05). Conclusions: Significant pain relief and improvement in quality of life among patients of chronic pancreatitis following surgery. However, worsening of exocrine function with only clinical improvement of endocrine function was also noted.

Quality of life assessment in patients treated due to chronic pancreatitis

“…There were however 9 patients, 7 with slight, and two with moderate disturbances, all within the conservatively treated group. Although this difference was not statistically significant in our 50-patients study, previous studies reported significant improvements within this component [28][29][30][31][32] .…”

“…The three patients remained with severe limitations in the performance of the usual activities within the conservative treatment group. The results are also in order with the previous studies reporting the significant improvement in usual activities performance [29][30][31][32] .…”

“…The comparison of these in the most commonly used SF36 questionnaire appears inappropriate, as this performance was more pronounced due to the psychological impairement, rather than the physical. Another component that might be considered is energy, which was not found to be significantly improved with surgery in other studies 32 .…”

“…and pancreatitis specific inventories, and some are demanding to complete 26,33 . Recently, major studies implemented SF12, which was later revised to version 2, and SF8 is also developed [27][28][29][30][31][32][33][34][35] . Patients with CP are usually not in the mood to complete questionnaires, especially when without symptoms, therefore, we aimed to evaluate our outcomes with the use of EQ-5D-5L, as a simplest, but sufficient tool for the QoL assessment 25 .…”

“…The remaining slight pain had no impact on functional performance of surgically treated patients. Although previous studies showed significant improvement in pain, as the most notable effect of the surgery, and majority of surgical procedures are aimed at the pain treatment [27][28][29][30][31][32]35 . Some studies separated the pain entity into general and pancreatic due to the specificity of the questionnaire 28,31 .…”