Predictors of Post-Operative Pain Relief in Patients with Chronic Pancreatitis Undergoing the Frey or Whipple Procedure

Amitasha Sinha, Yuval A. Patel, Michael Cruise, Karen Matsukuma, Atif Zaheer, Elham Afghani, Dhiraj Yadav, Martin A Makary, Kenzo Hirose, Dana K. Andersen, Vikesh Singh

Research output: Contribution to journalArticle

Abstract

Background: Post-operative pain relief in chronic pancreatitis (CP) is variable. Our objective was to determine clinical imaging or histopathologic predictor(s) of post-operative pain relief in CP patients undergoing the Whipple or Frey procedure. Methods: All patients who underwent a Whipple (n = 30) or Frey procedure (n = 30) for painful CP between January 2003 and September 2013 were evaluated. A toxic etiology was defined as a history of alcohol use and/or smoking. The pre-operative abdominal CT was evaluated for calcification(s) and main pancreatic duct (MPD) dilation (≥5 mm). The post-operative histopathology was evaluated for severe fibrosis. Clinical imaging and histopathologic features were evaluated as predictors of post-operative pain relief using univariable and multivariable regression analysis. Results: A total of 60 patients (age 51.6 years, 53 % males) were included in our study, of whom 42 (70 %) reported post-operative pain relief over a mean follow-up of 1.1 years. There were 37 (62 %) patients with toxic etiology, 36 (60 %) each with calcification(s) and MPD dilation. A toxic etiology, calcifications, and severe fibrosis were associated with post-operative pain relief on univariable analysis (all p <0.01). However, only a toxic etiology was an independent predictor of post-operative pain relief (OR 5.7, 95 % CI 1.3, 24.5, p = 0.02). Conclusion: Only a toxic etiology, and not imaging or histopathologic findings, independently predicts post-operative pain relief in CP patients undergoing the Whipple or Frey procedure.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 26 2016

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Keywords

  • Alcohol
  • Chronic pancreatitis
  • Post-operative pain relief
  • Smoking

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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