Abstract / Summary
Abstract Background Chronic pancreatitis (CP) is a progressive inflammatory disease associated with intractable pain and functional impairment of the pancreas. Although early surgery has been advocated, the clinically relevant timing of surgical intervention remains unclear. This study evaluated the association between surgical timing and recurrent postoperative pain, endocrine function, and nutritional outcomes in patients with CP. Methods We retrospectively reviewed the medical records of 65 patients who underwent surgery for CP between 2005 and 2024 after malignancy was excluded. Early surgery was clinically defined as surgery performed within 12 months (≤ 12 months) after initiation of medical or endoscopic treatment; surgery after 12 months (> 12 months) was classified as delayed. Recurrent postoperative pain, new-onset diabetes mellitus (DM) among patients without preoperative DM, and nutritional parameters were assessed. Potential confounding by treatment era was also evaluated. Results Nineteen patients underwent early surgery, and 46 underwent delayed surgery. Recurrent postoperative pain occurred in 0/19 (0%) versus 14/46 (30.4%) patients (p = 0.006), and new-onset DM occurred in 0/16 (0%) versus 8/32 (25.0%) eligible patients without preoperative DM (p = 0.039), respectively. The frequency of both outcomes increased with increasing duration of preoperative treatment. Early/delayed group distribution did not differ significantly between 2005–2014 and 2015–2024 (p = 0.357), although adverse outcomes were more frequent in the earlier era. In an era-adjusted Firth model, delayed surgery remained associated with the unfavorable composite outcome (OR 20.1, 95% CI 2.26–2656). The prognostic nutritional index improved after surgery, particularly in patients with preoperative malnutrition. Conclusions Longer preoperative treatment duration was associated with progressively higher risks of clinically significant postoperative pain recurrence and new-onset DM after surgery for chronic pancreatitis. Patients who underwent surgery within 12 months had particularly favorable outcomes. These findings suggest that surgical referral at approximately 1 year may warrant consideration when durable disease control with medical or endoscopic treatment appears unlikely. Prospective multicenter studies are needed to determine the optimal timing of surgery.