Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 28;23(4):676-686.
doi: 10.3748/wjg.v23.i4.676.

Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer

Eun-Ki Min  1 , Jae Uk Chong  1 , Ho Kyoung Hwang  1 , Sang Joon Pae  1 , Chang Moo Kang  1 , Woo Jung Lee  1
Affiliations

Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer

Eun-Ki Min et al. World J Gastroenterol. .

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: Pancreatectomy; Pancreatic cancer; Postoperative pain; Recurrence; Survival.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All authors have no financial relationships to disclose.

Figures

Figure 1
Figure 1
Patient eligibility. PDAC: Pancreatic ductal adenocarcinoma; NRS: Numerical rating scale; PD: Pancreaticoduodenectomy; PPPD: Pylorus-preserving pancreaticoduodenectomy; DP: Distal pancreatectomy with or without spleen preservation.
Figure 2
Figure 2
Overall changes in postoperative numerical rating scale pain intensity following pancreatectomy. POD: Postoperative day; NRS: Numerical rating scale.
Figure 3
Figure 3
Change in numerical rating scale pain intensity following pancreatectomy stratified by quality of pain control. A: Good pain control group (n = 109, PD; n = 53, DP); B: Poor pain control group (n = 37, PD; n = 13, DP). PD: Patients underwent pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy; DP: Patients underwent distal pancreatectomy; POD: Postoperative day; NRS: Numerical rating scale.
Figure 4
Figure 4
Oncologic outcomes. Comparison of overall survival between the good pain control group (solid line) and poor pain control group (dotted curve) after pancreaticoduodenectomy (PD) (A) and distal pancreatectomy (DP) (B); Comparison of disease-free survival between the good pain control group (solid line) and poor pain control group (dotted curve) after PD (C) and DP (D).
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29. - PubMed
    1. Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, Doi R, Monden M, Hatori T, Tanaka M, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101:908–915. - PMC - PubMed
    1. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–1481. - PubMed
    1. Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, Hwang R, Vauthey JN, Abdalla EK, Lee JE, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60. - PMC - PubMed
    1. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91:586–594. - PubMed

MeSH terms