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Pancreatectomy Safe for Chronic Pancreatitis
October 17, 2007 (New Orleans) — The risk of death nationally after pancreatectomy for chronic pancreatitis is surprisingly low vs comparable operations for cancer. This may justify more use of this procedure in appropriately selected patients to treat complications of chronic pancreatitis, including pain and/or obstructive sequelae.
These new findings were presented here at the American College of Surgeons 93rd Annual Clinical Congress by Joshua Hill, MD, a surgical resident at the University of Massachusetts Medical School in Worcester.
\"There are 2 to 10 cases of chronic pancreatitis per 100,000 people in the United States; about 80% of cases are due to chronic alcohol abuse,\" Dr. Hill told the audience. Treatment choices include analgesic therapy, drainage, and pancreatectomy.
The researchers wanted to investigate the presumed high perioperative risk of pancreatectomy, which has limited its use as a treatment. They used the Nationwide Inpatient Sample 1998 to 2004 to compare postoperative mortality of pancreatic resections performed for chronic pancreatitis with those performed for malignant neoplasm. Data about patient discharges with a primary diagnosis of chronic pancreatitis or pancreatic cancer were obtained from the database. Using in-hospital mortality as the primary outcome, data were analyzed by analysis of variance, chi-square, and multivariable logistic regression.
Of a total of 29,809 patients, 6407 had chronic pancreatitis, vs 23,408 with pancreatic cancer; mean age, respectively, was 62.1 with a standard error (SE) of 0.27, 50.9 (SE, 0.50), and 65.2 (SE, 0.20) (P < .0001); percentage of male patients in each group was 51.9%, 56.8%, and 50.6% (P < .0001); percentage of female patients was 48.1%, 43.2%, and 49.4% (P < .0001); percentage of white patients was 80.3%, 79.5%, and 80.5% (P < .003); and percentage of black patients was 9.5%, 12.7%, and 8.7% (P < .003).
Patients with pancreatic cancer were more likely to undergo resection compared with those with pancreatitis (11.6% vs 2.1%): 72.5% of those with neoplasms had pancreaticoduodenectomy, 24.1% had partial pancreatectomy, and 3.5% had total pancreatectomy (P < .001). Of those with chronic pancreatitis, 52% had partial pancreatectomy, 42.8% had total pancreatectomy, and 5.2% had total pancreatectomy (P < .001).
Overall in-hospital mortality (both resected and nonresected) was 15.7% for those with pancreatic cancer vs 0.6% for those with chronic pancreatitis. In-hospital mortality among just the nonresected patients with pancreatic cancer was 16.8% vs 0.6% for those with chronic pancreatitis.
Perioperative mortality was lower in those who underwent resection for pancreatitis vs cancer (partial resection: 1.6% vs 6.1%; P < .0001; pancreaticoduodenectomy: 2.3% vs 7.4%; P < .0001). Differences among those with total pancreatectomy were not significant because of the small sample size.
There was a higher mortality rate for those with neoplasm vs chronic pancreatitis (odds ratio [OR], 26.5; 95% confidence interval [CI], 21.2 – 33.7), for older vs younger patients (OR, 1.8; 95% CI, 1.6 – 2.1), and for women vs men (OR, 0.86; 95% CI, 0.9 – 0.8). Mortality rates were adjusted by Cox proportion hazards model.
Although the figures show that pancreatectomy is safe for those with chronic pancreatitis, only a small percentage of those patients undergo the procedure.
The researchers concluded that there is a surprisingly low mortality from pancreatectomy for those with chronic pancreatitis, which may justify less restrictive use of this procedure for the treating the complications of this disease.
Albert Lowenfels, MD, commented on the study for Medscape General Surgery: \"The difference in mortality rates between the 2 diseases is surprising. Very few centers do pancreatic resection with a 0.6% mortality rate. Also, few centers perform pancreatectomy for nonmalignant disease because of problems with fragile diabetes, especially in alcoholics.\"
He did concede that \"a few patients, such as the ones with hereditary pancreatitis, may benefit.\" Dr. Lowenfels is a professor of surgery and community preventive medicine at New York Medical Center, and emeritus surgeon in the Department of Surgery at Westchester Medical Center, both in Valhalla. He was not involved with the study.
Dr. Hill and Dr. Lowenfels have disclosed no relevant financial relationships. Dr. Lowenfels is a member of the Medscape General Surgery editorial board.
American College of Surgeons 93rd Annual Clinical Congress: Surgical Forum S81. Presented October 10, 2007. |
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发表于 2007-10-24 07:32:53