Surgery can help, but a healthy lifestyle is essential

By Amy Norton HealthDay Reporter

(Health Day)

TUESDAY, Jan. 24, 2023 (HealthDay News) — Many people who undergo surgery for chronic pancreatitis continue to have health problems in the years that follow, with some dying at young ages, according to a new study.

The study, carried out at a US medical center, is the largest to look at overall survival in the years following surgery for chronic pancreatitis – a condition in which the pancreas is permanently damaged by inflammation.

And he found that although short-term survival was high, more than a third of patients died within 10 years of surgery, often at a young age.

Among deceased patients, the median age at death was approximately 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 have long-term care after surgery.

“It can’t just be about going to see your primary care provider once a year,” said lead researcher Dr. Gregory Wilson, assistant professor of surgery at the University of Cincinnati School of Medicine. , Ohio.

Instead, he said, patients need ongoing care for physical health issues like diabetes, and in many cases, psychological counseling and care for addictions — whether at home. alcohol, tobacco or opioids that many patients are prescribed to manage their pain.

The pancreas is a vital organ that produces enzymes that aid digestion and hormones that regulate blood sugar. Chronic pancreatitis involves continuous inflammation of the organ that disrupts its normal functioning.

Its causes vary and are sometimes unknown, but long-term heavy drinking is a major contributor. Smoking is also a risk factor. Some cases are linked to inherited genetic mutations.

The disease also causes a range of problems: people may have to take digestive enzymes to manage weight loss and diarrhea, and many develop diabetes. But probably the most debilitating symptom is chronic abdominal pain, which means many patients use painkillers for years.

When these measures are not enough, surgery to remove part or all of the pancreas may ultimately be recommended.

“By the time patients come to see us,” Wilson said, “it’s not uncommon for them to be addicted to 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 points out, that’s not the end of the story.

The results – published on January 24 in the Journal of the American College of Surgeons – are based on 493 patients operated on for chronic pancreatitis. All were treated at 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%, even though most patients were middle-aged at the time of their surgery.

Wilson’s team also found that despite their severe disease, many patients continued to smoke (38%) or abuse alcohol (16%) in the years following surgery. And a quarter were still taking opioids daily.

In terms of causes of death, infections were the most common, followed by heart disease or stroke and complications from diabetes. Wilson said it was surprising to see infections top the list, and it’s unclear why. But, he speculated, it could be linked to diabetes, which can make people more susceptible to infections.

Just under 10% of deaths were attributed to drug addiction, while six patients died by suicide.

“This is a chronic, life-shortening disease,” said Dr. Emily Winslow, chief of hepatopancreatic-biliary surgery at MedStar Georgetown University Hospital in Washington, D.C.

Winslow, who was not involved in the study, agreed that patients needed long-term care for the various aspects of the disease, including help with continuing to smoke or drink, and psychological counselling.

She noted that while the number of suicide deaths in the study was relatively low, “that should get everyone’s attention.” Could some of these deaths, for example, be related to persistent chronic pain that surgery did not relieve?

The difficulty, Winslow said, is that there is no “quarterback” of the medical team when it comes to chronic pancreatitis. That makes it different from, say, heart disease, where a cardiologist is usually that leader.

Instead, Winslow said, the surgical team typically managed care for a few months after the procedure. Patients can also consult an endocrinologist for a diabetes management plan. But usually no one coordinates the whole situation.

“Patients need psychosocial support and post-surgery care,” Wilson said. “I wonder if that’s the piece we’re missing.”

Both doctors stressed that people with chronic pancreatitis should not fear surgery. Many patients do well afterwards — and, Winslow pointed out, problems with the disease will not be solved by avoiding surgery.

Instead, Wilson said, the system needs to do a better job of meeting patient needs.

The US National Institute of Diabetes and Digestive and Kidney Diseases has more on chronic pancreatitis.

SOURCES: Gregory Wilson, MD, assistant professor, surgery, University of Cincinnati College of Medicine, Ohio; Emily Winslow, MD, chief, hepatopancreatic-biliary surgery, MedStar Georgetown University Hospital, Washington, DC; Journal of the American College of Surgeons, January 24, 2023, online

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Surgery can help, but a healthy lifestyle is essential

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