REDUCED 10-year survival in patients who had undergone surgical intervention for chronic pancreatitis was linked to infection, cardiovascular disease, narcotic dependence, and other psychosocial issues, revealed Gregory C. Wilson, Assistant Professor of Clinical Surgery at the University of Cincinnati Pancreatic Disease Center, Ohio, USA, and colleagues.
The team highlighted that medical treatment is the first-line therapy for chronic pancreatitis, but a significant amount of these patients fail conservative measures and require surgical therapy. Based on disease morphology, including ductal anatomy and extent of parenchymal disease, surgical interventions can offer a conclusive resolution for these patients. The authors also underlined that long-term mortality rates after operative intervention for chronic pancreatitis remain insufficiently understood. They theorised that this is due to the difficulties with long-term follow-up for this cohort of patients.
The researchers utilised the University of Cincinnati Pancreatic Disease Center patient database to analyse 493 adults with chronic pancreatitis who underwent 555 operative interventions between 2000–2020, to establish long-term outcomes and survival within this population. 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, with a median follow-up of 83.9 months. A worse overall survival was linked to persistent opioid use, as revealed by a multivariable analysis. Amid the 165 reported deaths, common causes included infection (16.4%), cardiovascular disease (12.7%), diabetes complications (10.9%), substance abuse (9.7%), and progressive disease status/failure to thrive (7.9%).
The researchers highlighted that their 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.”
The researchers acknowledged that “persistent narcotic use, substance abuse, end-stage liver disease, and suicide are a major source of patient death.” They suggested that future investigations are “needed to evaluate interventions aimed at mitigating these potentially preventable causes of death.” They added: “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.”