Quality of life and outcomes after pancreaticoduodenectomy

Objective To assess the quality of life (QOL) and functional outcome of pat ients after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is gaining acceptance and i s being performed in increasing numbers for various malignant and benign di seases of the pancreas and periampullary region. There is a general impress ion that pancreaticoduodenectomy can severely impair QOL and alter normal a ctivities. Only a few small studies have evaluated QOL after pancreaticoduo denectomy. Methods A standard QOL questionnaire was sent to 323 patients surviving pan creaticoduodenectomy who had undergone surgery at The Johns Hopkins Hospita l between 1981 and 1997. Thirty items on a visual analog scale were categor ized into three domains: physical (15 items), psychological (10 items), and social (5 items). Scores are reported as a percentile, with 100% being the highest possible score. The same QOL questionnaire was also sent to laparo scopic cholecystectomy patients and healthy controls. A separate component of the questionnaire asked about functional outcomes acid disabilities. Results Overall QOL scores for the 192 responding pancreaticoduodenectomy p atients in the three domains (physical, psychological, social) were 78%, 79 %, and 81%, respectively. These QOL scores were comparable to those of the 37 laparoscopic cholecystectomy patients and the 31 healthy controls. The p ancreaticoduodenectomy patients were subgrouped into chronic pancreatitis, other benign disease, pancreatic adenocarcinoma, and other cancers. Patient s who underwent resection for chronic pancreatitis and pancreatic adenocarc inoma had significantly lower QOL scores in the physical and psychological domains compared with the laparoscopic cholecystectomy patients and the hea lthy controls. Common problems after pancreaticoduodenectomy were weight lo ss, abdominal pain, fatigue, foul stools, and diabetes. Conclusions This is the largest single-institution experience assessing QOL after pancreaticoduodenectomy. These data demonstrate that as a group, pat ients who survive pancreaticoduodenectomy have near-normal QOL scores. Many patients report weight loss and symptoms consistent with pancreatic exocri ne and endocrine insufficiency. Most patients have QOL scores comparable to those of control patients and can function independently in daily activiti es.