Association between chronic pancreatitis and pancreatic cancer at a central hospital in KwaZulu-Natal, South Africa

Authors

Keywords:

chronic pancreatitis, pancreatic cancer, pancreaticoduodenectomy, pancreatic ductal adenocarcinoma, periampullary carcinoma

Abstract

Background: The frequency of histological chronic pancreatitis (CP) evidence in the resident pancreas of resected periampullary cancers (PACs) has never been studied in Africa. This study aims to describe the spectrum of pathology and outcomes of pancreatic surgeries and address this deficit from a South African central hospital cohort.

Methodology: A retrospective audit of patients undergoing pancreatic surgery at Inkosi Albert Luthuli Central Hospital (IALCH) between 2003 and 2023 was conducted. The patient demographics, human immunodeficiency virus (HIV) status, histological subtypes, type and extent of surgery, and 30-day and overall mortality were captured from medical records. The presence of CP in the resident pancreas of patients resected for pancreatic and PAC was obtained from the pathology reports.

Results: Of the cohort, 72% were Africans, presenting at an earlier average age than other races. Surgery was performed on 126 (107 for cancer, 19 for CP) patients. Of these, 77 were pancreaticoduodenectomy (PD), of which 34 were for pancreatic ductal adenocarcinoma (PDAC). The prevalence of CP in the resident pancreas was 29.9%, and 55.9% in PDAC. Age was the only factor significantly associated with 30-day mortality, as well as long-term survival amongst patients with pancreatic and PAC. The overall median survival for patients with PAC was seven months; 11 patients are alive.

Conclusion: In a predominantly African cohort undergoing pancreatic surgery, PDAC presents at a younger age. The high perioperative mortality and low overall survival (OS) in the setting of high CP prevalence in the resident pancreas requires further investigation of its role in the aetiopathogenesis and prognosis in PDAC.

Author Biographies

FG Madela, University of KwaZulu-Natal

Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

MSA Sithole, University of KwaZulu-Natal

Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

NC Ntanzi, University of KwaZulu-Natal

Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

KS Chiliza, University of KwaZulu-Natal

Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

S Kader, University of KwaZulu-Natal

Department of Surgery, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

A Mwazha, University of KwaZulu-Natal

Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa

SR Thomson, University of Cape Town

Division of Gastroenterology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

C Aldous, University of KwaZulu-Natal

Department of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa

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Published

2024-05-15

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Section

Hepatobiliary Surgery