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

Yang, Chiou-Ying; Bliss, Lindsay A.; Schapira, Emily; Freedman, Steven D.; Ng, Sing Chau; Windsor, John A.; Tseng, Jennifer F.

doi:10.1007/s11605-014-2571-8

Cited by 74 publications

(59 citation statements)

References 32 publications

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“…If medical treatment is ineffective within a given, limited time period, or if endoscopic and/or surgical therapy are indicated, these more invasive treatments should not be unduly delayed in hopes of “spontaneous” pain relief over time (119). Patients who have failed or refused endoscopic or surgical therapy should be continued on the most effective medical approaches.…”

Section: Resultsmentioning

confidence: 99%

“…However, some patients may decline surgery, are too high risk for surgery or may improve sufficiently following initial endoscopic therapy to not require a definitive surgical approach (11). If patients do not significantly improve following endoscopic therapy and they are surgical candidates, then surgical treatment should not be delayed (119). …”

Section: Resultsmentioning

confidence: 99%

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Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

et al. 2016

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Description Pain in patients with chronic pancreatitis (CP) remains the primary clinical complaint and source of poor quality of life. However, clear guidance on evaluation and treatment is lacking. Methods Pancreatic Pain working groups reviewed information on pain mechanisms, clinical pain assessment and pain treatment in CP. Levels of evidence were assigned using the Oxford system, and consensus was based on GRADE. A consensus meeting was held during PancreasFest 2012 with substantial post-meeting discussion, debate, and manuscript refinement. Results Twelve discussion questions and proposed guidance statements were presented. Conference participates concluded: Disease Mechanism: Pain etiology is multifactorial, but data are lacking to effectively link symptoms with pathologic feature and molecular subtypes. Assessment of Pain: Pain should be assessed at each clinical visit, but evidence to support an optimal approach to assessing pain character, frequency and severity is lacking. Management: There was general agreement on the roles for endoscopic and surgical therapies, but less agreement on optimal patient selection for medical, psychological, endoscopic, surgical and other therapies. Conclusions Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

et al. 2016

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“…Recently, multiple studies have suggested that early surgery is superior in providing pain relief and improvement of quality of life, compared to the step-up approach in which medical therapy is followed by endoscopy and finally surgery [4-6]. Delaying invasive treatment such as surgery was negatively associated in an observational study, with the duration of pre-operative opioid use, multiple endoscopic interventions and the duration of chronic pancreatitis [4].…”

Section: Timing Of Surgery In Chronic Pancreatitismentioning

confidence: 99%

“…Sometimes as a last resort, surgical drainage and/or resection procedures are proposed in the case endoscopy fails. In the recent years increasing evidence tested the step-up approach, and multiple studies suggest the superiority of surgery compared to conservative and endoscopic measures [4-6]. This article describes the indications and different surgical procedures in chronic pancreatitis and puts focus on the timing of surgery in relation to other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Surgery in Chronic Pancreatitis: Indication, Timing and Procedures

et al. 2019

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Chronic pancreatitis is a chronic inflammation of the pancreas with pain as its severest symptom and often an impaired quality of life. Surgical intervention plays an important role in the management of pain but is generally kept as a last resort when conservative measures and endoscopy have failed. However, in the last few years multiple studies suggested the superiority of (early) surgical treatment in chronic pancreatitis for multiple end points, including pain relief. In this paper we highlight the most recent high-quality evidence on surgical therapy in chronic pancreatitis and the rationale for early (surgical) intervention.

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“…Even though studies have compared, endoscopy and surgery (8) no placebo-controlled studies have been performed and this question the effect of invasive treatments. Surgery has been stated to be the most effective treatment of pain in CP, and recent studies suggest early surgery for CP may even increase the likelihood of complete postoperative long-term pain relief (61). As anexample total pancreatectomy with islet cell transplantation is an emerging approach to treat patients with pancreatic pain.…”

Section: Theoretical Framework For Treatmentmentioning

confidence: 99%