Current Literature

Long-Term Survival after Operative Management of Chronic Pancreatitis: Two Decades of Experience

Wilson GC, Turner KM, Delman AM, et al. Long-Term Survival after Operative Management of Chronic Pancreatitis: Two Decades of Experience. J Am Coll Surg. 2022, in press.

The goal of this study was to determine the long-term outcomes of surgical treatments for chronic pancreatitis. The article reported outcomes based on 2 decades of experience in a single health system. The study cohort consisted of 493 patients who underwent 555 surgical procedures.

Total pancreatectomy with islet cell transplantation was performed in 48.5% of the cohort. Duodenum-preserving pancreatic head resection was performed in 21.7% of patients, pancreaticoduodenectomy in 16.2% and distal pancreatectomy in 12.8%. Idiopathic pancreatitis and alcoholic pancreatitis were the two most common reasons for treatment. Five-year survival was 81.3% but this decreased to 63.5% at 10 years of follow up. The most common causes of mortality were infections, cardiovascular events, and diabetes-related complications. Freedom from opioid use was documented in 73.1% of patients and, despite islet cell transplantation, nearly 60% of patients followed for a median of 83.9 months were insulin-dependent diabetics.

The authors concluded that the data support the need for close long-term follow up to deal with long-term opioid use disorder as well as infectious and diabetes-related complications.

This study was presented at the 2022 annual meeting of the Southern Surgical Association. In the discussion that followed the presentation, discussants emphasized the need for a multidisciplinary team approach for the long-term care of patients who are treated surgically for chronic pancreatitis. Specific interventions need to be developed to optimize care for diabetes and treat persistent opioid dependence.

Study Examines Frequency of Extramammary MRI Findings as Part of Initial Evaluation

Glocker, L. Roy N, Bernstein M, et al. Impact of Preoperative Extramammary Findings in Patients with Newly Diagnosed Breast Cancer. J Am Coll Surg. 2023, in press.

The authors of this study conducted a retrospective review of patients with newly diagnosed breast cancer over a 1-year interval to determine the frequency of extramammary findings on magnetic resonance imaging (MRI) with contrast obtained as part of the initial evaluation. A total of 480 patients were included in the analysis, of which 290 underwent MRI with contrast; extramammary findings were observed on MR images in 18% of patients, and 50% of this group underwent additional diagnostic studies. One malignant lesion was discovered tin the thymus of one patient. No metastatic breast cancer lesions were identified.  

The authors concluded that use of MRI as a component of the initial evaluation of early breast cancer was associated with a significant proportion of patients showing extramammary abnormalities, but new or metastatic malignant lesions were rarely diagnosed.

Outcomes for Prematurity, Birth Weight Improve for Children in Mothers after Metabolic Surgery

Rives-Lange C, Poghosyan T, Phan A, et al. Risk-Benefit Balance Associated With Obstetric, Neonatal, and Child Outcomes after Metabolic and Bariatric Surgery. JAMA Surg. 2023;158(1):36-44.

Most patients who undergo bariatric surgery for treatment of severe obesity are women of childbearing age, yet data regarding obstetric, neonatal, and child outcomes in this patient group are undependable due to a lack of strong evidence from prospective trials. This prospective study of patients (n = 3,686) with one pregnancy before and one after metabolic surgery compared rates of prematurity and birth weights in children born before and after metabolic surgery, as well as the frequencies of all pregnancy and child diagnoses in the study cohort.

Significant increases in rates of small for gestational age diagnoses were observed after metabolic surgery, along with a decrease in rates of large for gestational age. Significant decreases in rates of gestational hypertension and diabetes were observed in women who became pregnant after metabolic surgery. Events such as birth-related skeletal injuries, febrile convulsions, early childhood viral intestinal infections, and carbohydrate metabolism disorders were observed less often in children born after metabolic surgery; bronchiolitis and respiratory failure were observed more often after metabolic surgery. The authors concluded that significant benefits are observed in women who become pregnant after metabolic surgery and in children born after metabolic surgery, but additional long-term data are needed to further document benefits and risk.

Editorial

James T, Samakar K, Martin MJ. Special Delivery-Metabolic Bariatric Surgery as a Key Component of Maternal-Fetal Health Care. JAMA Surg. 2023;158(1):44-45.

In the editorial that accompanied the article, Tayler James, MD, and coauthors emphasized the need for additional long-term outcome studies to identify confounders that were unmeasured in this study and to provide additional insights into the possible causes of increased respiratory failure in children born after metabolic surgery.