Abstract
Background
The natural history after surgery for chronic pancreatitis is rarely reported.
Methods
Between 1970 and 1999, 174 patients underwent surgery for chronic pancreatitis and were followed until December 2006. They were divided in four groups: (1) resection 62; (2) drainage 82; (3) external drainage 7; (4) non-pancreas-directed surgery 23. A second procedure was required by 25 patients and a third by four: group 1 = 6 + 0, group 2 = 10 + 2, group 3 = 3 + 1, group 4 = 6 + 1.
Results
Hospital mortality was four of 174 (2.3%). Fifty-seven patients are alive; 49 of 170 developed cancer, and 38 died: lung (22), oral, pharynx, larynx (eight), esophagus, kidney, pancreas, colon, liver (two each), breast, stomach, mediastinum, prostate, melanoma, chronic myelogenous leukemia, squamous cancer of the auricle (one each), liver metastasis from unknown primary (two). Fifteen patients died of liver cirrhosis, 13 of myocardial infarction/decompensation, six of vascular problems, five each of acute renal insufficiency or cerebral diseases, four each of acute pancreatitis, accidental trauma, complications of diabetes, bronchopneumonia, and 19 of other causes. The overall 5-, 10-, 15-, 20-, 25-, and 30-year survival rate was 84.7, 65.6, 51.6, 38.0, 28.1, and 23.5.
Conclusions
Incidence of pancreatic cancer was 1.2%. The high incidence of smoking cancers (18.8%) is explained by the smoking habits of almost 100% of our patients. Eliminating smoking and increasing tests on organs at risk may prolong survival.
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References
DiMagno MJ, DiMagno EP. Chronic pancreatitis. Curr Opin Gastroenterol 2005;21:544–554. doi:10.1097/01.mog.0000175543.42582.55.
Ammann RW. Diagnosis and management of chronic pancreatitis: current knowledge. Swiss Med Wkly 2006;136:166–174.
Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich CD, et al. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 1996;14:141–145. doi:10.1038/ng1096-141.
Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001;120:682–707. doi:10.1053/gast.2001.22586.
Lankisch PG. Chronic pancreatitis. Curr Opin Gastroenterol 2007;23:502–507. doi:10.1097/MOG.0b013e3282ba5736.
Fasanella KE, Davis B, Lyons J, Chen Z, Lee KK, Slivka A, et al. Pain in chronic pancreatitis and pancreatic cancer. Gastroenterol Clin North Am 2007;36:335–364. doi:10.1016/j.gtc.2007.03.011.
Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 2003;35:553–558. doi:10.1055/s-2003-40237.
Cahen DJ, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007;356:676–684. doi:10.1056/NEJMoa060610.
Hartel M, Tempia-Caliera AA, Z’graggen K, Friess H, Büchler MW. Evidence based surgery in chronic pancreatitis. Langenbecks Arch Surg 2003;388:132–139.
Devière J, Bell RH Jr, Beger HG, Traverso LW. Treatment of chronic pancreatitis with endotherapy or surgery: critical review of randomized control trials. J Gastrointest Surg 2008;12:640–644. doi:10.1007/s11605-007-0448-9.
Ammann RW, Akovbiantz A, Largadèr F, Schueler G. Course and outcome of chronic pancreatitis: longitudinal study of a mixed medical–surgical series of 245 patients. Gastroenterology 1984;86:820–828.
Miyake H, Harada H, Kunichika K, Ochi K, Kimura I. Clinical course and prognosis of chronic pancreatitis. Pancreas 1987;2:378–385. doi:10.1097/00006676-198707000-00003.
Lankisch PG, Löhr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis: pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993;54:148–155.
Russell RCG, Theis BA. Pancreaticoduodenectomy in the treatment of chronic pancreatitis. World J Surg 2003;27:1203–1210. doi:10.1007/s00268-003-7239-6.
Thuluvath PJ, Imperio D, Nair S, Cameron JL. Chronic pancreatitis. Long term pain relief with or without surgery, cancer risk, and mortality. J Clin Gastroenterol 2003;36:159–165. doi:10.1097/00004836-200302000-00014.
Riediger H, Adam U, Fischer E, Keck T, Pfeffer F, Hopt UT, et al. Long term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007;11:949–960. doi:10.1007/s11605-007-0155-6.
Lankisch PG. Natural course of chronic pancreatitis. Pancreatology 2001;1:3–14. doi:10.1159/000055786.
Pedrazzoli S, Sperti C, Pasquali C. Pancreaticoduodenojejunostomy for chronic pancreatitis presenting with an inflammatory mass in the head of the pancreas. Pancreas 1995;11:289–293. doi:10.1097/00006676-199510000-00012.
Greenlee HB, Prinz RA, Aranha GV. Long-term results of side to side pancreaticojejunostomy. World J Surg 1990;14:70–76. doi:10.1007/BF01670548.
Duffy JP, Reber A. Surgical treatment of chronic pancreatitis. J Hepatobiliary Pancreat Surg 2002;9:659–668. doi:10.1007/s005340200091.
Sasco AJ, Secretan MB, Straif K. Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer 2004;45(Suppl.2):S3–9. doi:10.1016/j.lungcan.2004.07.998.
Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer 2008;122:155–164. doi:10.1002/ijc.23033.
Talamini G, Falconi M, Bassi C, Sartori N, Salvia R, Caldiron E, Frulloni L, Di Francesco V, Vaona B, Bovo P, Vantini I, Pederzoli P, Cavallini G. Incidence of cancer in the course of chronic pancreatitis. Am J Gastroenterol 1999;94:1253–1260. doi:10.1111/j.1572-0241.1999.01075.x.
Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, International Pancreatitis Study Group, et al. Pancreatitis and the risk of pancreatic cancer. N Engl J Med 1993;328:1433–1437. doi:10.1056/NEJM199305203282001.
Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 2002;51:849–852. doi:10.1136/gut.51.6.849.
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The authors gratefully acknowledge Tania Lazzarin for helping with the manuscript.
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Grant support: This study has been supported by the Ministero dell’Università e Ricerca Scientifica (Cofin 2005060715_001), Rome, Italy.
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Pedrazzoli, S., Pasquali, C., Guzzinati, S. et al. Survival Rates and Cause of Death in 174 Patients with Chronic Pancreatitis. J Gastrointest Surg 12, 1930–1937 (2008). https://doi.org/10.1007/s11605-008-0620-x
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DOI: https://doi.org/10.1007/s11605-008-0620-x