Quality of Life in Patients after Pancreaticoduodenectomy
Abstracts
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Introduction:Pancreaticoduodenectomy (PD) is being performed for increasing numbers of benign and malignant diseases of the periampullary region. With significantly altered upper GI anatomy and physiology, it would appear that quality of life (QOL) may be affected. The purpose of this study is to measure QOL using an instrument designed specifically for patients with GI disease. Methods: The GIQLI (Gastrointestinal Quality of Life Index) questionnaire was sent to 118 known survivors who had undergone PD between 1983 and 2001 at our institution. A GIQLI score was calculated for each of 5 domains (physical, social, psychological, disease specific items, and core symptoms). A total GIQLI score was calculated based on each of these subscales. Patients were analyzed according to diagnosis and pancreatic construct (pancreaticogastrostomy (PG) vs pancreaticojejunostomy (PJ)). Patients were asked how satisfied they were with their life before and after surgery. Scores were reported as a percentile with 100% being the highest possible score. Results: 95 patients (81%) responded to the questionnaire. The average GIQLI scores for the physical, social, psychological, disease specific, and core symptom domains were 61%, 75%, 73%, 41%, and 67% respectively. The average total QOL score was 72%. No significant differences in overall GIQLI scores or subscales were found for patients undergoing PD for benign vs malignant disease, or for patients with a PG vs PJ construct of the pancreatic remnant. Patients who underwent PG had a significantly greater weight loss 27 ? 24 vs 16 ? 15lbs (p=0.008). No statistical differences in QOL scores between pathologic diagnosis were found. After PD 55% of patients used pancreatic enzymes for symptoms of pancreatic exocrine insufficiency compared to 1% preoperatively. Nine patients who responded to the questionnaire (1%) were newly diagnosed with diabetes after surgery. Preoperatively 88% of the patients were satisfied with their lives compared to 90% after PD. Of the patients who were dissatisfied with their lives prior to surgery, 91% (10/11) were satisfied after operation. Conclusion: This validated QOL instrument showed no difference between patient groups defined by benign vs malignant disease, pathologic diagnosis, or anatomic construct. Furthermore, this very complete series of PD patients suggests that quality of life after surgery remains relatively unchanged. Although many patients report weight loss and symptoms related to pancreatic insufficiency, the majority are satisfied with life in general after PD. |
