Differences In Long-term Quality Of Life Research Articles

Effect of Intrathoracic or Cervical Anastomosis After Esophagectomy on Quality of Life.

We aimed to perform serial quality-of-life (QoL) evaluations and comparisons in patients after esophagectomy with intrathoracic anastomosis (IA) or cervical anastomosis (CA). Between November 2012 and March 2015, patients who underwent esophagectomy with IA or CA for mid-esophageal to distal esophageal or gastroesophageal junction cancer were followed up. QoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and esophagus-specific questionnaire (EORTC QLQ-OES18) before surgery, at discharge, and at 1, 6, 12, and 24 months after discharge. Linear mixed-effect models were used to assess the mean score differences (MDs) of each QoL scale between the two techniques, and changes in QoL over time. Potential confounders were adjusted. In total, 219 patients were analyzed (IA, n=127; CA, n=92). All patients' QoL decreased immediately after esophagectomy. Global QoL and most functioning and symptom scales exhibited a return to baseline levels within 2years of discharge, except for physical functioning and several symptoms (dyspnea, diarrhea, dysphagia, and reflux). There was no difference in overall health score between the two groups (MD 2, 95% confidence interval [CI] - 1 to 6). Compared with IA, patients with CA reported more trouble with taste (MD - 12, 95% CI - 19 to - 4) and talking (MD - 11, 95% CI - 19 to 2) at discharge. No differences in long-term QoL were found between groups. CA was associated with more trouble with taste and talking in the short term than IA. The long-term QoL did not differ between the two approaches.

Quality of Life after Inguinal Hernia Repair: Prospective, Multicenter Comparison of Modified Lichtenstein, Transabdominal Preperitoneal, and Totally Extraperitoneal Technique

INTRODUCTION: Our purpose was to compare quality of life (QOL) and recurrence after modified Lichtenstein (ML), transabdominal preperitoneal (TAPP), or totally extraperitoneal inguinal hernia repair (TEP IHR). METHODS: Prospective, multicenter, international data were queried for ML, TAPP, and TEP IHR outcomes. QOL data, with “Symptomatic” defined as a Carolinas Comfort Scale (CCS) score ≥2, was derived from third party–collected, patient-reported outcomes. Regression and subgroup analyses were used to determine confounders and significant predictors of QOL. RESULTS: A total of 2,619 patients were included (1,467 ML vs 628 TAPP vs 524 TEP). CCS was completed preoperatively (97.6%) and at 1 (87.6%), 6 (76.0%), 12 (83.4%), and 24 months (72.1%) postoperatively. Comparing techniques (ML vs TAPP vs TEP), there were more symptomatic TEP patients preoperatively (50.4% vs 53.8% vs 60.5%; p < 0.001), but no difference at 1 (25.0% vs 29.6% vs 24.0%; p = 0.062), 6 (13.8% vs 13.3% vs 13.3%; p = 0.062), 12 (13.1% vs 12.9% vs 16.4%; p = 0.193), or 24 months (11.5% vs 9.5% vs 11.7%; p = 0.485). In regression analysis, predictors of being symptomatic at 1 month included younger age (1.02/y, 1.001 to 1.022; p = 0.003), bilateral (1.6, 1.2 to 2.2; p < 0.001), preoperative symptoms (1.9, 1.5 to 2.4; p < 0.001), open vs TEP (1.4, 1.01 to 2.0; p = 0.014), and TAPP vs TEP (1.7, 1.2 to 2.4; p = 0.014). At 24 months, it included younger age (1.02/y, 1.01 to 1.03; p < 0.001), recurrent hernia (2.4, 1.5 to 3.7; p < 0.001), and preoperative symptoms (1.7, 1.2 to 2.4; p = 0.002). Recurrence was similar (2.9% vs 2.1% vs 3.1%; p = 0.76). Odds of recurrence were increased for patients with previous failed IHR (3.0, 1.2 to 7.0; p = 0.014). Subgroup analyses showed no difference in recurrence or QOL at any time point (Table 1), except increased symptoms 1 month after TAPP for unilateral, recurrent hernia (21.9% vs 44.1% vs 24.5%; p = 0.03). Compared with asymptomatic patients, patients with preoperative symptoms were more likely symptomatic 24 months after ML (6.9% vs 15.2%; p < 0.001) or TEP (8% vs 14.8%; p = 0.027), with a similar trend for TAPP (7.0% vs 12.1%; p = 0.057) with no difference in recurrence (ML: 2.4% vs 3.5%; p = 0.195, TAPP: 1.0% vs 2.9%; p = 0.311, and TEP: 2.7% vs 3.3%; p = 0.836). Table 1. - Proportion of Symptomatic Patients at 24 Month Follow-Up Characteristic ML TAPP TEP p Value * All hernia types (N = 1467 vs 628 vs 524)† 11.5% 9.5% 11.7% 0.48 Subgroups Unilateral primary hernia (N = 1258 vs 373 vs 267) 10.5% 8.9% 9.2% 0.67 Unilateral recurrent hernia (N = 116 vs 36 vs 72) 15.2% 19.2% 21.4% 0.63 Bilateral primary hernia (N = 84 vs 191 vs 162) 14.7% 7.6% 12.1% 0.24 Symptomatic preoperatively (N = 722 vs 329 vs 309) 15.2% 12.1% 14.8% 0.51 Nonsymptomatic preoperatively (N = 710 vs 283 vs 202) 6.9% 7.0% 8.0% 0.84 *p value determined using chi-square test.†Number of patients in ML vs TAPP vs TEP.ML, modified Lichtenstein; TAPP, transabdominal preperitoneal; TEP, totally extraperitoneal. CONCLUSION: There was no difference in long-term QOL or recurrence after laparoscopic (TEP/TAPP) vs open ML. Preoperative asymptomatic patients had better QOL outcomes than patients with symptoms. Surgeons should perform IHR with the technique in which they are most confident.

Stool dynamics after extrinsic nerve injury during right colectomy with extended D3-mesenterectomy

Introduction To improve oncological outcome in right colon cancer surgery, an extended mesenterectomy (D3) is under evaluation. In this procedure, all tissue anterior and posterior to the superior mesenteric vessels from the middle colic to ileocolic artery origin is removed, causing injury to the superior mesenteric nerve plexus. The aim was to study the effects of this injury on bowel dynamics and quality of life (QoL). Methods Patients undergoing right colectomy with conventional D2- and extended D3-mesenterectomy were asked to record stool number and consistency for 60 d after surgery and complete questionnaires regarding QoL and bowel function (BF) before and after recovery from surgery. We compared early postoperative stool dynamics and long-term QoL in the groups and presented graphs depicting the temporal profile of stool numbers and consistency. Results Thirty-three patients operated with a D3-resection and 12 patients with a D2-resection participated. The results revealed significantly higher stool numbers in the D3-group until day 26, with significantly more loose-watery stools until day 40. The most pronounced difference was found on day 9 (Mean difference in the total number of stools: 2.25 stools/day, p=.004. Mean difference in loose-watery stools/day: 2.81 p<.001). About 25% in the D2- and 69.7% in the D3-group reported having more than three stools/day in the early postoperative phase. There were no differences in long-term QoL and BF between the groups except in stool consistency (p=.039). Discussion/conclusions Denervation following extended D3-mesenterectomy leads to transitory reduced consistency and increased frequency. It does not affect long-term QoL or BF.

Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss and Quality of Life at 7 Years in Patients With Morbid Obesity

Laparoscopic sleeve gastrectomy (LSG) is currently the predominant bariatric procedure, although long-term weight loss and quality-of-life (QoL) outcomes compared with laparoscopic Roux-en-Y gastric bypass (LRYGB) are lacking. To determine weight loss equivalence of LSG and LRYGB at 7 years in patients with morbid obesity, with special reference to long-term QoL. The SLEEVE vs byPASS (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted between March 10, 2008, and June 2, 2010, in Finland. The trial enrolled 240 patients with morbid obesity aged 18 to 60 years who were randomized to undergo either LSG or LRYGB with a 7-year follow-up (last follow-up, September 26, 2017). Analysis was conducted on an intention-to-treat basis. Statistical analysis was performed from June 4, 2018, to November 8, 2019. Laparoscopic sleeve gastrectomy (n = 121) or LRYGB (n = 119). The primary end point was percentage excess weight loss (%EWL) at 5 years. Secondary predefined follow-up time points were 7, 10, 15, and 20 years, with included 7-year secondary end points of QoL and morbidity. Disease-specific QoL (DSQoL; Moorehead-Ardelt Quality of Life questionnaire [range of scores, -3 to 3 points, where a higher score indicates better QoL]) and general health-related QoL (HRQoL; 15D questionnaire [0-1 scale for all 15 dimensions, with 1 indicating full health and 0 indicating death]) were measured preoperatively and at 1, 3, 5, and 7 years postoperatively concurrently with weight loss. Of 240 patients (167 women [69.6%]; mean [SD] age, 48.4 [9.4] years; mean [SD] baseline body mass index, 45.9 [6.0]), 182 (75.8%) completed the 7-year follow-up. The mean %EWL was 47% (95% CI, 43%-50%) after LSG and 55% (95% CI, 52%-59%) after LRYGB (difference, 8.7 percentage units [95% CI, 3.5-13.9 percentage units]). The mean (SD) DSQoL total score at 7 years was 0.50 (1.14) after LSG and 0.49 (1.06) after LRYGB (P = .63), and the median HRQoL total score was 0.88 (interquartile range [IQR], 0.78-0.95) after LSG and 0.87 (IQR, 0.78-0.95) after LRYGB (P = .37). Greater weight loss was associated with better DSQoL (r = 0.26; P < .001). At 7 years, mean (SD) DSQoL scores improved significantly compared with baseline (LSG, 0.50 [1.14] vs 0.10 [0.94]; and LRYGB, 0.49 [1.06] vs 0.12 [1.12]; P < .001), unlike median HRQoL scores (LSG, 0.88 [IQR, 0.78-0.95] vs 0.87 [IQR, 0.78-0.90]; and LRYGB, 0.87 [IQR, 0.78-0.92] vs 0.85 [IQR, 0.77-0.91]; P = .07). The overall morbidity rate was 24.0% (29 of 121) for LSG and 28.6% (34 of 119) for LRYGB (P = .42). This study found that LSG and LRYGB were not equivalent in %EWL at 7 years. Laparoscopic Roux-en-Y gastric bypass resulted in greater weight loss than LSG, but the difference was not clinically relevant based on the prespecified equivalence margins. There was no difference in long-term QoL between the procedures. Bariatric surgery was associated with significant long-term DSQoL improvement, and greater weight loss was associated with better DSQoL. ClinicalTrials.gov Identifier: NCT00793143.

Short-term quality of life comparison of laparoscopic, open, and robotic incisional hernia repairs.

Outcomes of incisional hernia repair (IHR) include recurrence and quality of life (QOL). Operative approaches include laparoscopic, open, and robotic approaches. Data regarding comparative QOL outcomes among these repair types are unknown. Our study evaluates quality of life after three approaches to IHR. Patients undergoing open (OHR), laparoscopic (LIHR), and robotic extra-peritoneal (RIHR) at a single institution from 2009 to 2019 were reviewed from a prospectively managed quality database. Short-term QOL was compared among the three procedures using the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS), objective pain scores and postoperative narcotic use. Data regarding length of stay (LOS), emergency department (ED) visits, readmission, reoperations and surgical site infection (SSI) were also collected. A total of 795 patients undergoing IHR were analyzed (418 open, 300 laparoscopic and 77 robotic). Patient were similar in age, gender and co-morbidities. LIHR patients had higher BMI and RIHR patients had larger hernia and mesh size. LOS was longer and rate of SSI was higher for OIHR compared to laparoscopic and RIHR. Patients undergoing LIHR reported increased narcotic use, Visual Analogue Scale (VAS) and CCS pain scores compared to open and robotic repair. Return to daily activity was 4days shorter for robotic than open and laparoscopic repair; ED visits, readmissions, reoperations, and other QOL domains were similar. Our data suggests that short-term quality of life after robotic extra-peritoneal IHR is improved compared to open and laparoscopic repair. Additional follow up is required to determine differences in long-term QOL after IHR.

Quality of life considerations in uveal melanoma patients: a systematic review

ObjectiveThe aim of this study is to examine the quality of life (QOL) outcomes of patients undergoing different uveal melanoma (UM) treatments and to appraise the literature on the topic. Design and ParticipantsA systematic review was conducted to address the study objective. Patients undergoing UM treatment with or without metastasis were eligible for inclusion in this review. MethodsA literature search was performed using National Library of Medicine (PubMed), Embase, Ovid online, and Cochrane Central Register of Controlled Trials databases. We included all English, original retrospective or prospective studies published between January 1998 to September 2019 in which the primary outcome was the QOL of patients with treated UM. ResultsOur search strategy yielded 101 articles. Of these, 18 articles met all our inclusion criteria. The majority of included articles (61%) are cross-sectional studies. On average, each study employed 2 different QOL assessment tools. Overall, physical functioning and mental well-being are impaired in patients with UM after treatment compared with the general population. The severity of the impairment decreases as early as 3 months post-treatment; 8 of 12 studies comparing treatment options reported no statistical difference in physical functioning between treatments; 4 of 12 studies reported better visual function with radiation therapy compared with enucleation, 2 of which described no difference between the 2 options at long-term. Anxiety is more prevalent than depression, and both decrease to less than 10% at 1-year follow-up. ConclusionsOverall, there is no significant difference in long-term QOL in patients with UM from different treatment groups past 1-year follow-up. This work underscores the need for and importance of developing a standardized, complete assessment tool tailored to the challenges inherent to the diagnosis of UM.

Intrauterine closure of myelomeningocele is associated with superior long-term quality of life than postnatal closure: a single-center study.

The Management of Myelomeningocele Study (MOMS) established several important benefits of myelomeningocele fetal closure, including decreased need for shunting at 30 months. However, the effects of fetal closure on long-term quality of life (QOL) have not been studied. In this study, the authors aimed to analyze the differences in long-term QOL between children treated with intrauterine repair and those treated with postnatal repair. Caregivers of children treated with either intrauterine or postnatal closure at a tertiary acute care hospital between 1997 and 2003 were contacted to participate. The Pediatric Quality of Life Inventory (PedsQL 4.0) and a surgical history questionnaire were administered over the phone. Responses to the QOL survey were reverse scored and linearly transformed to a 0-100 scale, with a higher score indicating better QOL. The Mann-Whitney U-test was used to analyze differences in means. Seventy-four children had MMC repair between 1997 and 2003. Twenty-three (31%) of the patients' families responded to the PedsQL 4.0 questionnaire. Of these 23 children, 11 had intrauterine closure and 12 had postnatal closure. The intrauterine group did not differ in age (median [IQR] 17 years [14-17 years] vs 15 years [14-19 years], p = 0.926), sex (27.3% vs 41.7% male, p = 0.469), or lesion level (p = 0.199) from the postnatal group. Fewer patients in the intrauterine group underwent neurosurgical procedures than those in the postnatal group (55.6% vs 100%, p = 0.018). However, of the children receiving neurosurgical procedures, there was no difference in the number of procedures between the intrauterine and postnatal groups (median [IQR] 4 [2-10.5] vs 2.5 [1.75-6.25], p = 0.458). There was no difference in the percentage of children receiving nonneurosurgical procedures between the two groups (100% vs 100%, p > 0.99). Children who underwent intrauterine closure had significantly higher psychosocial health (median [IQR] 70.0 [56.7-83.3] vs 55.0 [42.1-60.0], p = 0.015) as well as total QOL (median [IQR] 56.5 [55.4-81.5] vs 49.5 [32.9-59.0], p = 0.019) than children with postnatal closure. Physical health was not significantly different between the two groups (median [IQR] 62.5 [37.5-78.1] vs 39.1 [18.8-59.4], p = 0.108). Relative to postnatal closure, children who underwent intrauterine closure of MMC demonstrated better long-term QOL as measured by psychosocial and overall QOL metrics. Given that not all medical and socioeconomic confounders were adjusted for due to the low sample size, validation of these results in a larger population and across multiple centers is needed.

Long-term outcomes and quality of life after surgical or conservative treatment of benign simple liver cysts.

Benign liver cysts are common and are often detected incidentally. Most patients do not require intervention. Occasionally, large dominant or multifocal small cysts cause symptoms as a result of rapid growth, secondary infection, intra-cystic bleeding or compression of adjacent organs. To compare presenting symptoms and outcomes of a consecutive series of patients with benign liver cysts treated either conservatively or by surgical intervention. Long-term quality of life (QoL) was also assessed. Retrospective analysis of prospectively collected data was conducted. Long-term general and disease-specific quality of life was also documented. Ninety-five patients were included in the study (46 treated operatively, 49 treated conservatively). 80% were female, and the mean age of the cohort was 58years. Those who had surgical intervention were older (62 vs 55years, p=0.004), were more likely to have shortness of breath at presentation (11 vs 5%, p=0.018) and had larger cysts (12 vs 4cm, p<0.001) compared with those offered conservative treatment. Laparoscopic stapled excision was the most common operative procedure (70%) and the overall complication rate was 20%. At a median follow-up of 64months, 17% (8/46) of the surgically treated patients had radiological evidence of cyst recurrence but only 9% (4/46) were symptomatic. At median follow-up of 71months, 37% (14/38) of conservatively treated patients had unchanged or new symptoms compared to the first presentation. Furthermore, 10% (4/38) of this group had additional radiological or surgical intervention for persistent symptoms during the follow-up period. Overall, there was no difference in long-term QoL between the two groups. Surgical intervention for selected patients with symptomatic benign liver cysts results in low long-term recurrence rates and excellent patient-reported outcomes and quality of life. Laparoscopic-stapled excision can be done safely and reliably in carefully selected patients.

Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer.

Patients' quality of life (QoL) deteriorates remarkably after gastrectomy. Billroth I reconstruction following distal gastrectomy has the physiological advantage of allowing food to pass through the duodenum. It was hypothesized that Billroth I reconstruction would be superior to Roux-en-Y reconstruction in terms of long-term QoL after distal gastrectomy. This study compared two reconstructions in a multicentre prospective randomized clinical trial to identify the optimal reconstruction procedure. Between January 2009 and September 2010, patients who underwent gastrectomy for gastric cancer were randomized during surgery to Billroth I or Roux-en-Y reconstruction. The primary endpoint was assessment of QoL using the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) questionnaire 36 months after surgery. A total of 122 patients were enrolled in the study, 60 to Billroth I and 62 to Roux-en-Y reconstruction. There were no differences between the two groups in terms of postoperative complications or mortality, and no significant differences in FACT-Ga total score (P = 0·496). Symptom scales such as epigastric fullness (heaviness), diarrhoea and fatigue were significantly better in the Billroth I group at 36 months after gastrectomy (heaviness, P = 0·040; diarrhoea, P = 0·046; fatigue, P = 0·029). The rate of weight loss in the third year was lower for patients in the Billroth I group (P = 0·046). The choice of anastomotic reconstruction after distal gastrectomy resulted in no difference in long-term QoL in patients with gastric cancer. NCT01065688 (http://www.clinicaltrials.gov).

Quality-of-life outcomes following pelvic exenteration for primary rectal cancer.

For patients with locally advanced tumours and contiguous organ involvement, pelvic exenteration (PE) can offer cure with relatively low mortality. The literature surrounding quality of life (QoL) in patients undergoing PE is limited. Furthermore, there are no matched comparisons of QoL between abdominoperineal resection (APR) and PE. The aim of this study was to compare differences in long-term QoL for patients with primary rectal cancer undergoing APR versus PE. All patients who underwent either APR or PE between January 2011 and December 2012 were identified. Patients were asked to complete the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire before surgery and 2 weeks afterwards. Subsequent questionnaires were requested at 3, 6, 12 and 24 months after operation. A total of 110 patients were included in the study (54 APR, 56 PE). Median length of stay following operation was 11 (range 3-70) days for APR and 15 (7-84) days for PE. Patients undergoing PE experienced lower physical (mean score 42 versus 56; P = 0.010), role (20 versus 33; P = 0.047), emotional (57 versus 73; P = 0.010) and social (34 versus 52; P = 0.005) functional levels 2 weeks after surgery. Long-term dyspnoea and financial worries were experienced only after PE. Patients undergoing PE had a lower overall global health status at 2 weeks after operation (40 versus 53; P = 0.012). Levels were comparable between groups from 3 months after surgery. QoL recovery following PE was equivalent to that after APR alone. Patients should not be denied exenterative surgery based on perceived poor QoL.

Does the site of anastomosis for esophagectomy affect long-term quality of life?

Long-term survival after esophagectomy is improving, and hence, quality of life (QOL) of these patients has become a priority. There has been extensive debate regarding the optimal site of surgical anastomosis (cervical or intrathoracic). We aimed to evaluate the impact of anastomotic site on long-term QOL postesophagectomy. Quality of life questionnaires (European Organisation for Research and Treatment of Cancer [EORTC] C-30 and OG-25) were sent to patients surviving over 3 years following esophagectomy. The data were analyzed by site of esophagogastric anastomosis: intrathoracic or cervical. EORTC C-30 data were compared against the reference population data. Of the patients, 62 responded (82%) with a median time postsurgery of 6.1 years (range 3-12 years). Patient demographics were comparable. There was no significant difference between cervical or intrathoracic anastomosis groups for functional or symptom scores, focusing on dysphagia (cervical = 8.8 vs. intrathoracic = 17.6, P = 0.24), odynophagia (cervical = 13.4 vs. intrathoracic = 16.1, P = 0.68) and swallowing problems (cervical = 8.1 vs. intrathoracic = 13.4, P = 0.32). There was no difference in overall health score between groups (cervical = 70.5 vs. intrathoracic = 71.6, P = 0.46). Overall general health score was comparable with the reference population (esophagectomy group P = 70.9 ± 22.1 vs. reference population = 71.2 ± 22.4, P = 0.93). There is no difference in long-term QOL after esophagectomy between patients with a cervical or intrathoracic anastomosis. Scores compare favorably with EORTC reference data. Survival after esophagectomy is associated with recovery of QOL in the long term, regardless of site of anastomosis and despite worse gastrointestinal-related symptoms.

Quality of Life After Surgery for Graves' Disease: Comparison of Those Having Surgery Intended to Preserve Thyroid Function with Those Having Ablative Surgery

Postoperative quality of life (QoL) after surgery for Graves' disease is not well documented, and the effect of different surgical operations has not been compared. This study examines the impact on QoL of a shift in policy from operations intended to preserve thyroid function (PF) to those ablating thyroid function (AF). A cross-sectional assessment was performed on patients who underwent surgery for Graves' disease between 1986 and 2008 in a tertiary endocrine surgical unit. Patients completed the Short Form 36 (SF-36) questionnaire by post. SF-36 scores, including the physical and mental component summaries, were compared with the general population and by operative intent (AF vs. PF). Statistical analyses were performed using SPSS 16.0. Of 150 patients, 3 had died of unrelated causes and 14 were not contactable. In the remaining 133 patients, the median age at time of assessment was 46 years (interquartile range 42-50) and 43 years (interquartile range 33-47) in the PF and AF groups, respectively. From these patients, 87 questionnaires (65.4% response rate) were completed with an item completion rate of 99.3%. The median follow-up was 18.4 years for PF and 7.9 years for AF surgery. Of 87 respondents, 38 (43.7%) underwent PF and 49 (56.3%) AF surgery. Study participants reported lower scores across all SF-36 subscales than British norms (p<0.05). Comparisons on operative intent showed no significant difference in long-term QoL (p>0.05). The shift to ablative surgery simplifies postoperative management with no adverse effect on QoL, justifying this practice from a patient perspective.

Comparison of Central and Extended Left Pancreatectomy for Lesions of the Pancreatic Neck

Central pancreatectomy (CP) is a parenchyma-sparing alternative to extended left pancreatectomy (ELP) for tumors of the pancreatic neck. We compared short- and long-term outcomes for the two approaches. Patients who underwent CP or ELP from 2000-2007 for neoplasms of the neck were identified. Charts were reviewed for patient, treatment, and outcome data. Long-term and quality-of-life (QoL) data were gathered through Institutional Review Board (IRB)-approved telephone interviews and questionnaires European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and QLQ-PAN26. 31 patients were identified; 13 underwent CP and 18 underwent ELP. Median follow-up was 29 months (range 5-90). Groups did not differ in age, American Society of Anesthesiologists (ASA) class, or preexisting diabetes mellitus (DM). CP patients had less gland resected (5.7 +/- 2.1 cm versus 10.8 +/- 2.8 cm) and lower postoperative mean blood glucose levels (120 +/- 15 mg/dl versus 136 +/- 24 mg/dl). CP patients experienced more complications (92% versus 39%), but no significant difference in major complications (38%, CP versus 17%, ELP; P = 0.17) or hospital stay (9 +/- 3 days, CP versus 7.5 +/- 4 days, ELP). There was one perioperative death in the CP group, unrelated to surgical technique. Questionnaire analysis showed no differences in functional or symptom scales. New-onset exocrine insufficiency was not significantly different between the groups (10%, CP versus 27%, ELP; P = 0.62), but the ELP group had a higher rate of new-onset DM (57% versus 11%; P = 0.04). CP is associated with more complications than ELP, but no difference in long-term QoL. Due to the lower incidence of postoperative DM, CP can be recommended for healthy patients with indolent tumors of the pancreatic neck.

Standard vs. Radical Pancreaticoduodenectomy for Periampullary Adenocarcinoma: A Prospective, Randomized Trial Evaluating Quality of Life in Pancreaticoduodenectomy Survivors

This study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard pancreaticoduodenectomy (pylorus preservation preferred) to radical pancreaticoduodenectomy (including distal gastrectomy and retroperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men (66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P < 0.001), and a longer postoperative length of hospital stay (13.6 days vs. 10.1 days; P < 0.01). The FACT-Hep total QOL scores were similar between the standard and radical groups: 143.5 vs. 147.3, respectively. Additionally, the individual FACT-G subscale scores evaluating physical (22.1 vs. 23.3), social (24.5 vs. 24.4), emotional (19.2 vs. 19.6), and functional well-being (20.6 vs. 22.4) were comparable between the standard and radical groups. Subgroup analyses based on pathologic diagnosis (pancreatic, ampullary, distal bile duct, etc.) failed to reveal any differences in QOL assessment between the standard and radical pancreaticoduodenectomy groups. Finally, QOL measures were similar when comparing time since operation (<2 years' follow-up vs. >2 years' follow-up) and age (≤65 years vs. >65 years). This is the largest report comparing QOL assessment in survivors of pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma. ( J Gastrointest Surg 2003;7:1–11.)