Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 676-686
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.676
Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer
Eun-Ki Min, Jae Uk Chong, Ho Kyoung Hwang, Sang Joon Pae, Chang Moo Kang, Woo Jung Lee
Eun-Ki Min, Yonsei University College of Medicine, Seoul 03722, South Korea
Jae Uk Chong, Ho Kyoung Hwang, Chang Moo Kang, Woo Jung Lee, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
Jae Uk Chong, Ho Kyoung Hwang, Chang Moo Kang, Woo Jung Lee, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul 03722, South Korea
Sang Joon Pae, National Health Insurance Corporation Ilsan Hospital, Goyang 10444, South Korea
Author contributions: Min EK, Chong JU and Hwang HK performed the research, analyzed the data, and wrote the paper; Pae SJ contributed to the analysis and provided clinical advice; Kang CM and Lee WJ designed the research and supervised the report.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Yonsei University College of Medicine, Seoul 03722, South Korea.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Individuals can’t be identified according to the data presented.
Conflict-of-interest statement: All authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Moo Kang, MD, PhD, Associate Professor, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Ku, Seoul 03722, South Korea. cmkang@yuhs.ac
Telephone: +82-2-22282120 Fax: +82-2-3138289
Received: October 4, 2016
Peer-review started: October 8, 2016
First decision: October 28, 2016
Revised: November 14, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: January 28, 2017
Processing time: 107 Days and 9.5 Hours
Abstract
AIM

To investigate the association between postoperative pain control and oncologic outcomes in resected pancreatic ductal adenocarcinoma (PDAC).

METHODS

From January 2009 to December 2014, 221 patients were diagnosed with PDAC and underwent resection with curative intent. Retrospective review of the patients was performed based on electronic medical records system. One patient without records of numerical rating scale (NRS) pain intensity scores was excluded and eight patients who underwent total pancreatectomy were also excluded. NRS scores during 7 postoperative days following resection of PDAC were reviewed along with clinicopathologic characteristics. Patients were stratified into a good pain control group and a poor pain control group according to the difference in average pain intensity between the early (POD 1, 2, 3) and late (POD 5, 7) postoperative periods. Cox-proportional hazards multivariate analysis was performed to determine association between postoperative pain control and oncologic outcomes.

RESULTS

A total of 212 patients were dichotomized into good pain control group (n = 162) and poor pain control group (n = 66). Median follow-up period was 17 mo. A negative impact of poor postoperative pain control on overall survival (OS) was observed in the group of patients receiving distal pancreatectomy (DP group; 42.0 mo vs 5.0 mo, P = 0.001). Poor postoperative pain control was also associated with poor disease-free survival (DFS) in the DP group (18.0 mo vs 8.0 mo, P = 0.001). Patients undergoing pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy (PD group) did not show associations between postoperative pain control and oncologic outcomes. Poor patients’ perceived pain control was revealed as an independent risk factor of both DFS (HR = 4.157; 95%CI: 1.938-8.915; P < 0.001) and OS (HR = 4.741; 95%CI: 2.214-10.153; P < 0.001) in resected left-sided pancreatic cancer.

CONCLUSION

Adequate postoperative pain relief during the early postoperative period has important clinical implications for oncologic outcomes after resection of left-sided pancreatic cancer.

Keywords: Pancreatic cancer, Pancreatectomy, Survival, Postoperative pain, Recurrence

Core tip: This is a retrospective review to evaluate the association between postoperative pain control and oncologic outcomes in resected pancreatic ductal adenocarcinoma. In multivariate analysis, poor patients’ perceived pain control was an independent risk factor for both disease-free survival (HR = 4.157; 95%CI: 1.938-8.915; P < 0.001) and overall survival (HR = 4.741; 95%CI: 2.214-10.153; P < 0.001) in resected left-sided pancreatic cancer. Adequate postoperative pain control to reduce patients’ perceived pain during immediate postoperative period may be as important as adjuvant therapy in resected left-sided pancreatic cancer.