Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2021; 9(35): 10927-10936
Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10927
Surgery for chronic pancreatitis in Finland is rare but seems to produce good long-term results
Mikael Parhiala, Juhani Sand, Johanna Laukkarinen
Mikael Parhiala, Johanna Laukkarinen, Faculty of Medicine and Health Technology, Tampere University, Tampere 33521, Finland
Juhani Sand, Johanna Laukkarinen, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere 33520, Finland
Author contributions: Sand J and Laukkarinen J designed the study; Parhiala M contributed to the permits process, data collection and analysis; all authors contributed to the writing of the manuscript.
Supported by Medical Research Fund of Pirkanmaa Hospital District, No. 9X024; and Sigrid Jusélius Foundation, No. MS424.
Institutional review board statement: The study was approved by the Ethics Committee of Tampere University Hospital, Finland (ETL code R16153). The data from the HILMO register was provided by the Finnish National Institute for Health and Welfare with a license/permission (THL/1854/5.05.00/2012).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work.
Data sharing statement: We are not give permission to share data because the data is being used to future studies and patient data is not allowed to be shared because of the EU Regulation on the protection of personal data.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Johanna Laukkarinen, MD, PhD, Professor, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Elämänaukio, Kuntokatu 2, Tampere 33520, Finland. johanna.laukkarinen@pshp.fi
Received: January 16, 2021
Peer-review started: January 16, 2021
First decision: May 4, 2021
Revised: May 19, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: December 16, 2021
Abstract
BACKGROUND

Abdominal pain in chronic pancreatitis (CP) may require invasive interventions. Surgical procedures are rare, and little is known about the long-term results.

AIM

To study the nationwide frequency of pancreatic surgery for CP in Finland, and postoperative symptoms and quality of life (QoL).

METHODS

All patients in Finland with a diagnosis of CP who had undergone pancreatic surgery during 2000-2008 were selected from a national register. Only patients with CP as an indication for pancreatic surgery were included. Medical records were studied and questionnaires QLQ-C30, PAN26 and AUDIT, and symptom questionnaires were sent out.

RESULTS

During the 9-year period, pancreatic surgery for CP was performed on 30 patients [77% men, median age 45 (21-62) years]. Eighty-three percent underwent endoscopic procedures before surgery. Surgery was performed a median 2 (0-10) years after the original CP diagnosis, and 17% developed postoperative complications. Primary pain relief after surgery was reported in 70% of cases. Need for strong pain medication was lower after surgery. Eight of 21 (38%) returned the questionnaires and 88% reported that surgery had reduced their pain and 63% were almost or entirely pain-free at a median 14 (10-18) years after surgery. QoL results did not differ from those in our control Finnish CP group.

CONCLUSION

Surgery for CP is rare in Finland and most patients had prior endoscopic procedures. Patients who returned the questionnaires reported less pain and good QoL during the 14-year follow-up.

Keywords: Surgery, Pain, Chronic pancreatitis, Quality of life, Complication

Core Tip: Our study provides valuable insight on the current state of chronic pancreatitis (CP) surgery for chronic pain in Finland. We included all the CP patients who underwent surgery for CP symptoms during 2000-2008 in Finland. We found that surgery is rare. We estimate that 0.6%-0.8% of CP patients undergo surgery for CP pain, which produces good long-term effects. Opiate usage was reduced after surgery. Most of the patients had undergone endoscopic procedures before surgery. Complications after CP surgery were rare.