Long-Term Quality of Life and Gastrointestinal Functional Outcomes after Pancreaticoduodenectomy
Casey J. Allen*, Danny Yakoub*, Francisco I. Macedo*, Austin R. Dosch*, Jessica Brosch*, Vikas Dudeja*, Rhonda Ayala*, Nipun B. Merchant
University of Miami Miller School of Medicine, Miami, FL
Objectives: Long-term quality of life (QoL) and gastrointestinal (GI) function after pancreaticoduodenectomy (PD) is largely unknown. We perform a longitudinal assessment of these outcomes in patients following PD in a global cohort.
Methods: The SF-36, a health-related QoL questionnaire, and the GSRS, a rating scale for GI symptoms, were administered to patients who underwent PD identified from a global online support group. QoL and GSRS were scored on a validated standard scale, analyzed across subgroups based on time after PD and compared to pre-operative measurements and established values of a general healthy population (GHP).
Results: 927 patients responded to the questionnaire. 501(54%) underwent PD for malignancy, age was 57±12y, 327(35%) were male, and median follow-up was 2.0y (5d-30.7y). Emotional and physical domains of QoL improve with time and surpass pre-operative levels 6mo-1y after PD (both p<0.001), while GI symptoms remain similar to pre-operative levels over time (p=0.125); however neither approach levels in the GHP (Fig 1). No differences are seen between those with and without cancer. Pancreatic insufficiency persists in 66% of survivors >5y (n=193), with 18% diagnosed >1y after PD.
Conclusions: Long-term QoL and functional outcomes in survivors following PD improve over time but never approach those of the GHP. GI dysfunction and pancreatic insufficiency persist in the majority of long-term survivors. Long-term physical, psychosocial and GI functional support after PD should be encouraged.
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