Quality of Life and Long-Term Survival after Surgery for Chronic Pancreatitis

Taylor A. Sohn, Kurtis A. Campbell, Henry A. Pitt, Patricia K. Sauter, Joann Coleman, Keith D. Lillemoe, Charles J. Yeo, John L. Cameron

Research output: Contribution to journalArticle

Abstract

The objective of this study was to evaluate the short-term and long-term outcome as well as quality of life in patients undergoing surgical management of chronic pancreatitis. Between January 1980 and December 1996, a total of 255 patients underwent surgery for chronic pancreatitis at The Johns Hopkins Hospital. The etiology of the disease, indications for surgery, patient characteristics and long-term survival were analyzed. A visual analog quality-of-life questionnaire containing 23 items graded on a scale of 0 to 10 (0 = worst and 10 = best) was sent to patients postoperatively. Visual analog responses relating to before and after the chronic pancreatitis surgery were compared using a paired t test. During the 17-year review period, 263 operations were performed for chronic pancreatitis in 255 patients. The most common presenting symptoms were abdominal pain (88%), weight loss (36%), nausea/vomiting (30%), jaundice (14%), and diarrhea (12%). The cause of the pancreatitis was presumed to be alcohol in 43%, idiopathic in 38%, pancreas divisum in 5%, ampullary abnormality in 4%, and gallstones in 3%. Pancreaticoduodenectomy was the most common procedure in 96 patients (37%), followed by distal pancreatectomy in 67 (25%), Puestow procedure in 52 (19%), sphincteroplasty in 37 (14%), and Duval procedure in five (2%). The overall mortality and morbidity rates were 1.9% and 35%, respectively. Two hundred twenty-seven (89%) of the 255 patients were alive at last follow-up. For the entire cohort of patients, the 5- and 10-year actuarial survivals were 88% and 82%, respectively. One hundred six (47%) of the 227 living patients responded to the visual analog quality-of-life questionnaire. Patients reported improvements in all aspects of the quality-of-life survey including enjoyment out of life, satisfaction with life, pain, number of hospitalizations, feelings of usefulness, and overall health (P <0.005). In addition to improved quality of life after surgery, narcotic use was decreased (41% vs. 21%, P <0.01) and alcohol use was decreased (59% vs. 33%, P <0.001). However, patients often became insulin-dependent diabetics (12% vs. 41%, P <0.0001) and required pancreatic enzyme supplementation (34% vs. 55%, P <0.01) after surgical intervention. These data suggest that surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and excellent long-term survival. Moreover, this study evaluates quality of life in a standardized analog fashion, with highly significant improvement reported in all quality-of-life measures. We conclude that surgery remains an excellent option for patients with chronic pancreatitis.

Original languageEnglish (US)
Pages (from-to)355-365
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume4
Issue number4
DOIs
StatePublished - Jan 1 2000

Keywords

  • Pancreatitis
  • Quality of life
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Sohn, T. A., Campbell, K. A., Pitt, H. A., Sauter, P. K., Coleman, J., Lillemoe, K. D., Yeo, C. J., & Cameron, J. L. (2000). Quality of Life and Long-Term Survival after Surgery for Chronic Pancreatitis. Journal of Gastrointestinal Surgery, 4(4), 355-365. https://doi.org/10.1016/S1091-255X(00)80013-X