TH2.7 Pancreatitis and Cancer. An evaluation of clinical practice with focus on links to the development of pancreatic cancer

Abstract

Aim Pancreatitis is a common surgical pathology that burdens all healthcare systems. Acute or chronic presentations require dedicated resources and evidence-based management. Literature suggests increased risk of cancer is two-fold with acute and up to 8-fold with chronic pancreatitis. Our study aims: 1. Assess current practice against NCEPOD 2016 guidelines, 2. Explore the incidence of cancer. Method Prospectively collected electronic records and clinical systems were interrogated from Jan 2015 to Feb 2018. Data was collected on patient demographics, analytics, clinical outcomes and follow up. All patients and hospital episodes’ data were included. Results Over the 3 years, 337 patients presented with a male: female ratio of 1:1. Median age was 61.2 (IQR 51.3–74.4). Diagnosis was acute pancreatitis 82% and chronic 18%. Aetiology was biliary 63%, alcohol-related 20% and idiopathic 10%. Ca19–9 was performed in 10% overall; and IgG4 in 10% of unknown aetiology. Ultrasound scan within 24 hours performed in 62% (improved to 79% on re-audit after an educational campaign). Within the study period, 120 patients completed 5 years follow up. 4 patients developed cancer: 3 (1.1%) in acute group and 1 (1.6%) in chronic pancreatitis group. All had Ca19–9 levels done at initial presentation with values of 6310, 19, 14 and 239u/ml respectively. Conclusions Compliance with guidelines is improved through awareness and clinical focus, to the benefit of patients. Pancreatitis can be an early marker of cancer, and Ca 19–9 (best validated serum tumour marker) may help clinical suspicion. Larger multi-centred collaborations may further the knowledge base.