Care must continue ‘well after date of surgery’ in patients with chronic pancreatitis
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Infection, cardiovascular disease, narcotic dependence and other psychosocial issues were among causes linked to reduced 10-year survival in patients who underwent surgical intervention for chronic pancreatitis, researchers reported.
“Medical treatment is first-line therapy for chronic pancreatitis,” Gregory C. Wilson, MD, FACS, assistant professor of clinical surgery at the University of Cincinnati Pancreatic Disease Center, and colleagues wrote in the Journal of the American College of Surgeons. “However, a significant number of these patients fail conservative measurements and require surgical therapy. Surgical interventions, based on disease morphology including ductal anatomy and extent of parenchymal disease, can provide a definitive resolution for these patients.”
They continued: “Long-term mortality rates after operative intervention for chronic pancreatitis remains poorly understood, possibly due to the difficulties with long-term follow-up for this cohort of patients. Additionally, cause of death, which is an important data point to scale patient driven interventions to prevent early mortality, is infrequently described in the literature.”
Seeking to determine long-term outcomes and survival in this population, Wilson and colleagues used the University of Cincinnati Pancreatic Disease Center patient database to analyze 493 adults (median age, 44.8 years; 59% women; 86.6% white) with chronic pancreatitis who underwent 555 operative interventions between 2000 and 2020.
While idiopathic pancreatitis was the most common etiology (41.8%), researchers also cited lifestyle factors such as alcohol use (28%) and smoking (3%), genetic polymorphisms (10%) and pancreatic divisum (7.7%) as causes.
Most patients underwent total pancreatectomy (48.5%), followed by duodenal preserving pancreatic head resection (21.7%), Whipple procedures (16.2%), distal pancreatectomy (12.8%) and other surgical procedures (0.8%). Repeat operations were performed in 12% of patients at a median of 20.6 months following the first intervention.
At a median follow-up of 83.9 months, median overall survival was 202.7 months, and survival estimates at 1, 5 and 10 years were 95.5%, 81.3% and 63.5%, respectively. Multivariable analysis showed persistent opioid use (HR = 3.91; 95% CI, 2.45-6.24) was associated with worse overall survival.
Among the 165 reported deaths (median age, 50.6 years), common causes included infection (16.4%), cardiovascular disease (12.7%), diabetes mellitus complications (10.9%), substance abuse (9.7%) and progressive disease status/failure to thrive (7.9%).
“This study serves as a benchmark for outcomes in patients with refractory chronic pancreatitis requiring surgical intervention. It also identifies a major area of need in this patient population. The care for these patients must continue well after the date of surgery,” Wilson and colleagues wrote. “Persistent narcotic use, substance abuse, end-stage liver disease and suicide are a major source of patient death. Future studies are needed to evaluate interventions aimed at mitigating these potentially preventable causes of death.”
They continued, “Although the exact timing of this intervention is unclear, based on clinical experience and data from this study, 4 to 6 months after surgery may represent an ideal time to start these efforts.”
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