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Variance in elective surgery for chronic pancreatitis.
Nehal S Shah1, Ajith K Siriwardena
1Hepatobiliary Surgical Unit, Manchester Royal Infirmary, Manchester, United Kingdom.
JOP : Journal of the Pancreas
|January 9, 2009
Summary
Optimal surgical treatment for chronic pancreatitis lacks evidence. Studies show poor reporting of quality of life and disease assessment, highlighting a need for standardized criteria and validated quality of life testing before surgery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Limited evidence exists for optimal surgical treatment in painful chronic pancreatitis.
- Inconsistent baseline assessment data complicates patient staging across different centers.
Purpose of the Study:
- To systematically review elective surgical interventions for chronic pancreatitis.
- Focus on quality of life reporting, baseline assessment, and the relationship between disease characteristics and surgical procedures.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases (January 1997 - March 2007).
- Analysis of 46 manuscripts reporting on 4,626 patients undergoing elective surgery for chronic pancreatitis.
Main Results:
- Quality of life questionnaires reported in only 17.4% of studies (9.5% of patients).
- Pre- and post-operative pain score comparisons in 32.6% of manuscripts.
- Formal rationale for procedure selection based on disease variant provided in only 15.2% of reports (10.4% of patients).
Conclusions:
- Significant lack of standardization in operative intervention criteria for painful chronic pancreatitis.
- Recommend mandatory formal quality of life testing using validated systems for all patients prior to elective surgery.
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