K. A. Lewellen1, T. K. Maatman1, M. A. Heimberger1, E. P. Ceppa1, M. G. House1, A. Nakeeb1, C. M. Schmidt1, N. J. Zyromski1 1Indiana University School Of Medicine,General Surgery,Indianapolis, IN, USA
Introduction:
Necrotizing pancreatitis presents a unique clinical challenge due to its lengthy disease course, therapeutic complexity, and numerous associated complications. Pancreatic necrosis occurs in 15-20% of acute pancreatitis patients and may result from any etiology of acute pancreatitis. Scattered reports describe pancreatic tumors causing necrotizing pancreatitis; however, the relationship between these disease processes has not yet been fully elucidated. We have treated a number of patients whose necrotizing pancreatitis was caused by pancreatic adenocarcinoma and therefore sought to clarify the clinical outcomes of these patients.
Methods:
Review of an institutional database identified necrotizing pancreatitis patients treated between 2008 and 2018. Medical record analysis of those with necrotizing pancreatitis and pancreatic adenocarcinoma included patient demographics, date of diagnosis of necrotizing pancreatitis, date of diagnosis of pancreatic adenocarcinoma, management details, and date of last follow up or death.
Results:
Among 647 patients treated for necrotizing pancreatitis during this time frame, seven patients (1.1%; two females, five males) had pancreatic adenocarcinoma contemporaneous with necrotizing pancreatitis. The mean age at diagnosis of necrotizing pancreatitis was 60.6 years (range 49-66). Two patients had post-procedural pancreatitis after cancer diagnosis, the remaining five had pancreatitis caused by adenocarcinoma. The average duration between diagnosis of necrotizing pancreatitis and diagnosis of pancreatic adenocarcinoma was 245 days (range 23-655). For pancreatic adenocarcinoma treatment, three patients received chemotherapy alone, one received palliative radiation therapy, and one died without oncologic management. One patient’s treatment plan was unknown. Only one patient underwent operative resection of pancreatic adenocarcinoma. Median survival was 12.0 months (range 0.4-49.9).
Conclusion:
These data suggest that pancreatic adenocarcinoma may be a more common cause of necrotizing pancreatitis than previously considered. The long duration between diagnosis of necrotizing pancreatitis and pancreatic adenocarcinoma highlights the diagnostic and therefore therapeutic delay in this patient population. Pancreatic adenocarcinoma should be considered in necrotizing pancreatitis patients of this age group in whom etiology is otherwise unclear. Prompt diagnosis of pancreatic adenocarcinoma facilitates optimal treatment in this extremely challenging clinical situation.