Long term outcomes of surgery in chronic pancreatitis

Abstract

Introduction: Chronic Pancreatitis(CP) has high prevalence in India and is mostly idiopathic(ICP). The onset is at a young age and presents with recurrent abdominal pain and progressive pancreatic endocrine and exocrine dysfunction. Various surgical procedures for CP show good short term results, but the long term outcomes remain unclear. Methods: 75patients who underwent various surgeries for CP were analysed retrospectively. Patients operated more than 2years prior were included. They were followed-up with a questionnaire to assess their pain relief (Izbicki pain score), exocrine and endocrine function and quality of life (QOL) (using EORTC QLQ-30 questionnaire). Results: 75patients underwent surgeries for CP over 12years. During follow-up 17 patients had expired. 21 were lost to follow-up. Remaining 37patients were included in the analysis. Tropical pancreatitis was the etiology in 54%. 59.5% patients were of age 21 to 40 years. Pain was the indication for surgery in 97%. 51% had pancreatic duct diameter more than 6mm. 78%(29/37) underwent resectional procedures. Mean duration of follow-up was 80months. 75% patients complained of persistent pain but at lower intensity. A significant percentage of patients developed diabetes or had worsening sugar control 49-70 months after surgery. Of 17 patients who had expired at follow-up, 3 developed pancreatic malignancy. The cause of death in 8 patients was unknown. Conclusion: In spite of good early results, majority of patients of CP have pain recurrence in the long run. The high long term mortality we noticed in our study is disturbing and needs to be studied in a larger patient cohort.