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Long-term Quality of Life and Gastrointestinal Functional Outcomes After Pancreaticoduodenectomy

Allen, Casey J., MD; Yakoub, Danny, MD, PhD; Macedo, Francisco Igor, MD; Dosch, Austin R., MD; Brosch, Jessica, BS; Dudeja, Vikas, MD; Ayala, Ronda, RN; Merchant, Nipun B., MD

doi: 10.1097/SLA.0000000000002962
PAPERS OF THE 138TH ASA ANNUAL MEETING
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Objective: To perform a comprehensive assessment of long-term quality of life (QOL) and gastrointestinal (GI) function in patients following pancreaticoduodenectomy (PD).

Summary of Background Data: Survival after PD has greatly improved and thus has resulted in a larger population of survivors, yet long-term QOL and GI function after PD is largely unknown.

Methods: Patients were identified from a global online support group. QOL was measured using the Short Form-36, while GI function was assessed using the Gastrointestinal Symptom Rating Scale. QOL and GI function were analyzed across subgroups based on time after PD. QOL was compared with preoperative measurements and with established values of a general healthy population (GHP). Multivariate linear regression was used to identify predictors of QOL.

Results: Of the 7605 members of the online support group, 1102 responded to the questionnaire with 927 responders meeting inclusion criteria. Seven hundred seventeen (77.3%) of these responders underwent PD for malignancy. Mean age was 57 ± 12 years and 327 (35%) were male. At the time of survey, patients were 2.0 (0.7, 4.3) years out from surgery, with a maximum 30.7-year response following PD. Emotional and physical domains of QOL improved with time and surpassed preoperative levels between 6 months and 1 year after PD (both P < 0.001). Each GI symptom worsened over time (all P < 0.001). Independent predictors of general QOL in long-term survivors (> 5 years) included total GSRS score [β = −1.70 (−1.91, −1.50)], female sex [β = 3.58 (0.67, 6.46)], and being a cancer survivor [β = 3.93 (0.60, 7.25)].

Conclusions: Long-term QOL following PD improves over time, however never approaches that of a GHP. GI dysfunction persists in long-term survivors and is an independent predictor of poor QOL. Long-term physical, psychosocial, and GI functional support after PD is encouraged.

Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.

Reprints: Nipun B. Merchant, MD, Division of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, 1120 NW 14th Street, CRB 410, Miami, FL 33136. E-mail: nmerchant@med.miami.edu.

CJA participated in the collection, analysis, and interpretation of data; statistical expertise and evaluation; drafting and revision of the manuscript, figures, and tables.

DY, FIM, ARD, and VD participated in the collection, analysis and interpretation of data; drafting and revision of the manuscript, figures, and tables.

JB participated in the collection of data.

RA participated in conception and experimental design; analysis and interpretation of data; drafting and revision of the manuscript.

NBM had overall responsibility for the study, including conception and experimental design; analysis and interpretation of data; drafting and revision of the manuscript, figures and tables; statistical expertise and evaluation; supervision.

These data were presented at the 138th Annual Meeting of the American Surgical Association, April 21, 2018, Phoenix, AZ.

This study is a cross-sectional analysis.

None of the authors have declared conflicts of interest.

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