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Among 493 patients who underwent surgery for chronic pancreatitis, the survival rate 1 year after the operation was 95.5%.
At 5 years, it was 85%. But by the 10-year mark, the survival rate had dropped to 63.5%, a new study found.
This “much lower” long-term survival means there is “a need for closer monitoring after surgery,” the American College of Surgeons said in a news release about the findings.
Persistent smoking or opioid use after surgery was associated with increased mortality, according to the investigators. The study was published online January 24 in the Journal of the American College of Surgeons.
“We saw issues related to substance abuse, xenical without a prescription narcotics abuse, suicide, and end-stage liver disease,” Gregory C. Wilson, MD, assistant professor of surgery at the University of Cincinnati College of Medicine and the study’s lead author, said in the news release.
Survival tended to be worse when chronic pancreatitis was caused by alcohol use or smoking.
Patients with chronic pancreatitis experience severe abdominal pain, and about 40% undergo surgery to remove all or part of the pancreas. Few studies have investigated outcomes beyond 5 years after surgery, according to the researchers.
For the new study, Wilson and his colleagues used the National Death Index to assess long-term survival after surgery for chronic pancreatitis.
They analyzed data from patients who underwent surgery at their institution between 2000 and 2020. Procedures included total pancreatectomy (48.5%), duodenal preserving pancreatic head resection and/or drainage (21.7%), pancreaticoduodenectomy (16.2%), and distal pancreatectomy (12.8%).
The cause of chronic pancreatitis was unknown in 41.8% of cases. Known causes included alcohol consumption (28% of the cases) and genetic polymorphisms (10%).
The median age of the patients was 44.8 years, and 165 died during the study period. The median age at death was 50.6 years. The most common causes of death were infections (16.4%), cardiovascular disease (12.7%), diabetes complications (10.9%), substance abuse (9.7%), and progressive chronic pancreatitis or failure to thrive (7.9%).
Other causes included cancer (7.3%) and suicide (3.6%).
Most patients ― 73% ― were not using opioids at long-term follow-up, according to the researchers. Persistent use of the painkillers was associated with significantly worse overall survival (hazard ratio, 3.91; 95% CI, 2.45 – 6.24), the investigators report.
About 59% of patients had diabetes and depended on insulin.
“After surgical intervention, we, as surgeons, expect that we return these patients back to their normal lives,” Wilson said. But the study found “a large portion of these patients who are dying within 10 years of this operation.”
Need for Multidisciplinary Care
Clinicians should look out for the overall health and psychosocial well-being of these patients after surgery, and new interventions may be needed, Wilson said.
His team is working with the University of Cincinnati’s Center for Addiction Research to find ways to address substance abuse post surgery.
“We need physicians and care providers from all different disciplines, not just surgery, caring for these patients,” Wilson said.
Hunza Chaudhry, MD, and Devang Prajapati, MD, with University of California, San Francisco, Fresno, have studied outcomes of patients with chronic pancreatitis. They likewise called for multidisciplinary approaches to the problem.
“This study highlights that postoperative care, which a lot of times is provided by primary care clinicians, is imperative” in addressing mental health, smoking cessation, cardiovascular health, diabetes management, and cancer screening, they told Medscape Medical News in an email.
The timing of deaths in the study suggests that mortality was related to chronic pancreatitis and its associated conditions, rather than the surgical intervention, they said.
“Our previous study showed patients with chronic pancreatitis have high frailty scores, which is associated with increased mortality,” Chaudhry and Prajapati said.
Physicians may be seeing more cases of pancreatitis. Another study found that rates of alcohol-induced pancreatitis increased significantly during the pandemic. “Clinicians should be aware of these findings, as we might see the sequelae of this in our clinical practice,” they say.
The researchers, Chaudhry, and Prajapati have disclosed no relevant financial relationships.
J Am Coll Surg. Published online January 24, 2023. Abstract
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