Long-Term Survival Outcomes after Operative Management of Chronic Pancreatitis: Two Decades of Experience

• Published in: Journal of the American College of Surgeons Vol. 236; no. 4; pp. 601 - 610
• Main Authors: Wilson, Gregory C, Turner, Kevin M, Delman, Aaron M, Wahab, Shaun, Ofosu, Andrew, Smith, Milton T, Choe, Kyuran A, Patel, Sameer H, Ahmad, Syed A
• Format: Journal Article
• Language: English
• Published: United States 01-04-2023
• Subjects: Chronic Disease; Diabetes Mellitus - etiology; Humans; Pancreatectomy - methods; Pancreaticoduodenectomy; Pancreatitis, Chronic - surgery; Transplantation, Autologous; Treatment Outcome
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1097/XCS.0000000000000575

Chronic pancreatitis is a debilitating, life-altering disease; however, the long-term outcomes after operative intervention have not been established.
Patients who underwent operative intervention at a single institution between 2000 and 2020 for chronic pancreatitis were included, and survival was assessed using the National Death Index.
A total of 493 patients who underwent 555 operative interventions for chronic pancreatitis during 2 decades were included. Of these patients, 48.5% underwent total pancreatectomy ± islet autotransplantation, 21.7% underwent a duodenal preserving pancreatic head resection and/or drainage procedure, 16.2% underwent a pancreaticoduodenectomy, and 12.8% underwent a distal pancreatectomy. The most common etiology of chronic pancreatitis was idiopathic (41.8%), followed by alcohol (28.0%) and known genetic polymorphisms (9.9%). With a median follow-up of 83.9 months, median overall survival was 202.7 months, with a 5- and 10-year overall survival of 81.3% and 63.5%. One hundred sixty-five patients were deceased, and the most common causes of death included infections (16.4%, n=27), cardiovascular disease (12.7%, n=21), and diabetes-related causes (10.9%, n=18). On long-term follow-up, 73.1% (n=331) of patients remained opioid free, but 58.7% (n=266) had insulin-dependent diabetes. On multivariate Cox proportional hazards modeling, only persistent opioid use (hazard ratio 3.91 [95% CI 2.45 to 6.24], p < 0.01) was associated with worse overall survival.
Our results represent the largest series to date evaluating long-term survival outcomes in patients with chronic pancreatitis after operative intervention. Our data give insight into the cause of death and allow for the development of mitigation strategies and long-term monitoring of comorbid conditions.