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Health-Related Quality of Life and Functional Outcomes in 5-year Survivors After Pancreaticoduodenectomy
Zhi Ven Fong1
, Donna M Alvino1
, Carlos Fernández-del Castillo1
, Ryan D Nipp1
, Lara N Traeger1
, Margaret Ruddy1
, Carrie C Lubitz1
, Colin D Johnson2
, David C Chang1
, Andrew L. Warshaw1
, Keith D Lillemoe1
, Cristina R Ferrone1
1Massachusetts General Hospital, Boston, MA; 2University of Southampton, Southampton, United Kingdom
OBJECTIVE(S): Long-term quality of life (QOL) after pancreaticoduodenectomy (PD) is unknown. Our aim was to assess QOL and functionality in a large cohort of patients ≥5-years after PD.
METHODS: The EORTC QLQ-C30 questionnaire was administered to patients who underwent PD between 1998 to 2011. Cohort’s scores were compared to an age- and gender-adjusted normal population. Clinical relevance (CR) of differences were scored as small (5-10), moderate (10-20), or large (>20) based on validated interpretation of clinically important differences.
RESULTS: Of 307 ≥5-year PD survivors, 243 (79.3%) responded, of whom 64.1% underwent PD for non-malignant lesions. Median follow-up was 9.1yrs (range 5.2yrs-15.4yrs). New-onset diabetes developed in 6.9%; 50.4% take pancrelipase; 54.6% take antacid medication. Compared to the age- and gender-adjusted controls, 5-year PD survivors demonstrated higher global QOL (78.7 vs 69.7, CR small, p<0.001), physical (86.7 vs 77.9, CR small, p<0.001) and role-functioning scores (86.3 vs 74.1, CR medium, p<0.001). On linear regression adjusting for socioeconomic variables, there were no differences in QOL or functional scores in the benign vs malignant subgroups. Age at operation was independently associated with physical-functioning (-0.4/year, p=0.008). Taking pancrelipase (-6.8, p=0.035) or antacids (-6.3, p=0.044) was independently associated with lower social-functioning scores.
CONCLUSIONS: Patients who had a PD demonstrated better global QOL, physical- and role-functioning scores at 5-years when compared to age- and gender-adjusted controls. Approximately half of patients required pancrelipase or antacids, while only 7% developed new-onset diabetes. Concerns over impaired QOL or functional status should not weigh negatively in the consideration for PD.
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