Previous cholecystectomy, gastrectomy, and diabetes mellitus are not crucial risk factors for pancreatic cancer in patients with chronic pancreatitis

Introduction: In the general population, cholecystectomy, diabetes. and chr onic pancreatitis seem to be associated with an increased risk of developin g pancreatic cancer. Aims: We assessed whether previous cholecystectomy, gastrectomy, or diabete s mellitus may be risk factors for pancreatic cancer in patients with chron ic pancreatitis. Methodology: We analyzed 853 patients with chronic pancreatitis (110 women, 743 men) with a median follow-up period of 14 years with particular refere nce to establishing which patients had previously undergone cholecystectomy or distal gastric resection (Billroth II anastomosis) or had diabetes or g allstone disease and the respective time scales involved. Results: Pancreatic cancer developed in 17 patients with chronic pancreatit is after a median period of 8 years from onset of pancreatitis symptoms (ra nge, 3-38 years). Excluding two cholecystectomies performed 1 year before d iagnosis of cancer. cholecystectomy was performed in 7/17 (41%) patients wi th pancreatic cancer and in 381/836 (46%) of the other patients with chroni c pancreatitis. Forty-nine (10%) patients with chronic pancreatitis and no pancreatic cancer had undergone cholecystectomy during the years before the onset of chronic pancreatitis, whereas none of the patients in whom a panc reatic malignancy developed had undergone cholecystectomy before the onset of chronic pancreatitis symptoms. Gastrectomies were performed in 116 patie nts (14%), 47 before the onset of chronic pancreatitis. Only 2/17 patients with pancreatic cancer had undergone previous gastrectomy, though in both c ases only shortly before diagnosis of the cancer. Diabetes was diagnosed in 353 patients. but only in 30 (4%) before onset of chronic pancreatitis. On ly 1/17 patients (6%) with pancreatic cancer had long-standing diabetes, wh ereas diabetes developed in 3/17 shortly before diagnosis of pancreatic can cer. Conclusions: Cholecystectomy, gastrectomy, and diabetes are not major risk factors for the development of pancreatic cancer in patients with chronic p ancreatitis.