Background: The natural history of chronic pancreatitis (CP) pts after surgery is rarely reported. (J Clin Gastroenterol 2003;36:159-65).
Methods: Between 1970 & 1999, 193 pts underwent surgery (S) for CP. After review 19 pts were excluded: 12 post SAP and 4 post-traumatic pseudocysts, 2 Vater’s papilla stenosis, 1 IPMN. 174 pts (mean age 45±10.2; range 24-75 yrs) were followed with clinical examination, CT or MR, and/or telephone interview. They were divided in 4 Groups: 1) Resective S: 62 [Whipple (41), left pancreatectomy with (6) or without (13) pancreaticojejunostomy, Warren procedure (2)]. 2) Derivative S: 82 [Puestow (20), Partington-Rochelle or Frey (44), cystojejunostomy (12) or cystoduodenostomy (1), fistulojejunostomy (1), personal procedure (4). 3) Non pancreas directed S: 23 [Cholecystectomy (1) &/or surgical sphincteroplasty or choledochoduodenostomy (19), bilateral splanchnicectomy (1), embolization of a bleeding pseudoaneurysm (1), remake of a hepaticojejunostomy after a Whipple (1)]. 4) Marsupialization: 7. A second S was required in 23 pts, a third in 4 of them: Group 1: 6+0, Group 2: 11+2, Group 3: 3+1, Group 4: 3+1. The actual status at December 31 2006 of all pts was retrieved. The cause of death was retrieved for 111/117 pts. Of the 6 remaining, 1 died abroad, and privacy prevented us to retrieve the cause for the other 5.
Results: Hospital mortality was 4/174 (2.3%). 57 pts (32.8%) are still alive. 49 pts (28.2%) developed cancer and 38 died of their cancer, 5 of another disease, 1 of unknown cause, and 5 are still alive. The more frequent was the lung cancer (22 pts) followed by oral, pharynx, larynx and esophageal cancers (10 pts). A small pancreatic cancer (PC) was found in the surgical specimen in 3 pts: 1 died of PC 18.3 years later, 1 died of unknown cause 30.5 years later, and 1 is alive & well 29 years later. A further patient died of PC 9 years after surgery. The other main causes of death were: liver cirrhosis (15 pts), vascular disease (11 pts), MI or failure (10 pts), acute pancreatitis, accidental trauma, complications of diabetes, bronchopneumonia (4 pts each). The overall 5, 10, 15, 20, 25 and 30 years survival rate was 82.8, 63.5, 49.7, 36.4, 27.5 and 23.1 and was the same for the 4 groups (P=0.8447).
Conclusions: The incidence of PC was 2.3%, but only 1 (0.6%) appeared during follow-up. The high incidence of lung, oral, pharynx, larynx & esophageal cancers (32/170; 18.8%) during follow-up is due to the smoking habits of almost 100% of our pts (Int J Cancer 2008;122:155-64). Eliminating smoking and increasing tests on organs at risk of cancer during follow-up may prolong survival in these pts.