Long-term quality of life after resection of pancreatic neuroendocrine tumors

Abstract

Background: Survival after curative intent surgery for pancreatic neuroendocrine tumors (PNET) is high, yet long-term outcomes including pancreatic insufficiency (EPI), new-onset diabetes (DM) and quality of life (QoL) are poorly investigated. Long-term QoL may very depending on the type of resection performed. Method: PNETs who underwent curative intent surgery between 1993-2018, with >1-year of follow-up were included. QoL was assessed using 3 validated questionnaires: the EQ-5D-5L, QLQ C-30 and QLQ GI-NET21. QoL was analysed among subgroups based on type of surgery, pancreatoduodenectomy (PD), distal pancreatectomy (DP), or enucleation (EN), and compared to a reference population. Sensitivity analyses included complications Clavien-Dindo grade ≥3 and follow-up duration (≤5, 5-10, ≥10 years). Results: 93/138 patients responded to the questionnaires. Median follow-up duration was 99 (5-307) months. Thirty (33.7%) patients underwent PD, 29 (32.6%) patients DP, and 29 (32.6%) patients EN. Twenty-five (28.0%) patients had severe postoperative complications, 28 (20%) developed new-onset DM, and 55 (40%) developed EPI. Mean daily-health status and index scores (EQ-5D-5L), and all domains of the QLQ-C30 except for pain, were significantly lower for PNETs than for the general population (change in QoL of >10%, p< 0.05). EN patients had highest over-all QoL in most EQ-5D-5L, QLQ-C30, and GI-NET21 domains. No differences in QoL were seen in the sensitivity analyses. Conclusion: QoL of resected PNETs was significantly lower than in the general population and this reduction remained stable until more than 10 years after surgery. EN patients had better QoL compared to other types of resections.