By Amy Norton HealthDay Reporter
(Health day)
TUESDAY, Jan. 24, 2023 (HealthDay News) — Many people who have surgery for chronic pancreatitis continue to have health problems in later years, and some die at an early age, a new study finds.
The study, conducted at a US medical center, is the largest to look at overall survival in the years after surgery for chronic pancreatitis, a condition in which the pancreas is permanently damaged due to inflammation.
And it found that while short-term survival was high, more than a third of patients died within 10 years of surgery, often at a young age.
Among the patients who died, the median age at death was about 50 years. That means half were younger than that.
Experts said the findings underscore how serious chronic pancreatitis can be and how important it is for patients to receive long-term care after surgery.
“It can’t just be going to your primary care provider once a year,” said lead researcher Dr. Gregory Wilson, an assistant professor of surgery at the University of Cincinnati School of Medicine in Ohio.
Instead, he said, patients need ongoing care for physical health conditions such as diabetes and, in many cases, counseling and care for addiction, whether to alcohol, smoking or the opioids many patients are prescribed. to control your pain.
The pancreas is a vital organ that produces enzymes that aid digestion and hormones that regulate blood sugar. Chronic pancreatitis involves ongoing inflammation in the organ that disrupts its normal function.
Its causes vary and are sometimes unknown, but long-term binge drinking is a big contributor. Smoking is also a risk factor. Some cases are related to inherited genetic mutations.
The condition also causes a variety of problems: People may have to take digestive enzymes to control weight loss and diarrhea, and many develop diabetes. But possibly the most debilitating symptom is chronic abdominal pain, which means many patients use painkillers for years.
When those measures are not enough, ultimately surgery may be recommended to remove part or all of the pancreas.
“By the time patients come to see us,” Wilson said, “it’s not uncommon for them to be dependent on opioids just to get through the day.”
Surgery can often relieve pain and improve people’s quality of life, he noted.
But as the new study highlights, that’s not the end of the story.
The findings, published Jan. 24 in the Journal of the American College of Surgeons, are based on 493 patients who underwent surgery for chronic pancreatitis. All were treated at the Cincinnati Medical Center between 2000 and 2020.
Overall, more than 95% were still alive one year after surgery. But 10 years later, the survival rate had dropped to 63%, despite the fact that most patients were middle-aged at the time of surgery.
Wilson’s team also found that despite the severity of the disease, many patients continued to smoke (38%) or abuse alcohol (16%) in the years after surgery. And a quarter continued to take opioids on a daily basis.
Regarding the causes of death, infections were the most frequent, followed by heart disease or stroke, and complications of diabetes. Wilson said it was surprising to see infections topping the list, and it’s not clear why. But, he speculated, it could be related to diabetes, which can make people more vulnerable to infection.
Just under 10% of the deaths were attributed to substance abuse, while six patients died by suicide.
“This is a chronic, life-shortening disease,” said Dr. Emily Winslow, chief of hepatopancreaticobiliary surgery at MedStar Georgetown University Hospital in Washington, DC.
Winslow, who was not involved in the study, agreed that patients need long-term care for various aspects of the disease, including help to continue smoking or drinking, and counseling.
He noted that while the number of suicide deaths in the study was relatively small, “it should draw everyone’s attention.” Could some of those deaths, for example, be related to ongoing chronic pain that was not relieved by surgery?
The difficulty, Winslow said, is that there is no “quarterback” on the medical team when it comes to chronic pancreatitis. That makes it different from, say, heart disease, where a cardiologist is often the lead.
Instead, Winslow said, the surgical team would typically manage care for a few months after the procedure. Patients can also see an endocrinologist for a diabetes management plan. But usually, no one is coordinating the big picture.
“Patients need care and psychosocial support after surgery,” Wilson said. “I wonder if that’s the missing piece.”
Both doctors stressed that people with chronic pancreatitis should not fear surgery. Many patients do well afterward, and, Winslow noted, disease-related problems won’t be resolved by avoiding surgery.
Instead, Wilson said, the system needs to do a better job of meeting the needs of patients.
The US National Institute of Diabetes and Digestive and Kidney Diseases has more about chronic pancreatitis.
SOURCES: Gregory Wilson, MD, assistant professor, surgery, University of Cincinnati School of Medicine, Ohio; Emily Winslow, MD, chief of hepatopancreaticobiliary surgery, MedStar Georgetown University Hospital, Washington, DC; Journal of the American College of Surgeons, January 24, 2023, online
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