Standard versus Radical Pancreaticoduodenectomy for Periampullary Adenocarcinoma: Evaluation of Quality of Life in Pancreaticoduodenectomy Survivors
Abstracts
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OBJECTIVE: Study designed to assess quality of life (QOL) of patients who had undergone either standard or radical pancreaticoduodenectomy (PD). BACKGROUND: PD has been performed in increasing numbers for periampullary adenocarcinoma (PA). Past reports comparing standard (pylorus-preservation) vs. radical (to include distal gastrectomy and retroperitoneal lymphadenectomy) resection have suggested that the more extensive resection is attended by negative functional outcomes and poorer QOL, thereby negating the potential survival advantage of the radical resection. METHODS: A prospective, randomized single institution trial comparing standard to radical PD evaluated 294 patients with PA between 1996 and 2001. A QOL survey designed for hepatobiliary cancer (FACT-G + Hep) was sent to 150 of these patients, surviving PD. RESULTS: One hundred and five QOL surveys (70%) were returned and analyzed at a mean of 2.2 years postop, with 55 of the patients having been randomized to the standard group, and 50 to the radical group. The two groups were statistically similar with respect to age at operation, race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a higher percentage of men (66% vs 44%; p=0.02), longer operative time (369 min vs 327 min; p= 0.005), and longer postop length of stay (15 days vs 11 days; p=0.08). The total QOL scores were similar between the standard and radical groups: 143.5 (95% CI = 135.9 to 151.2) vs 147.3 (95% CI = 141.1 to 153.5), 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, respectively. Subgroup analyses based upon pathologic diagnosis (pancreatic, ampullary, etc) failed to reveal differences in QOL assessment between the standard and radical PD groups. Finally, QOL measures were similar when comparing time since operation (< 2 yrs follow-up vs > 2 yrs follow-up) and age (<65 yrs vs > 65 yrs). CONCLUSIONS: This is the largest report comparing QOL assessment in survivors of PD 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 PD for PA. |
