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Long-Term Quality of Life Is Similar After Hepatic Resection for Malignant and Benign Diseases
Vanessa Banz*, Regula Fankhauser, Peter Studer, Beat Gloor, Daniel Inderbitzin, Daniel Candinas
University Hospital Bern, Bern, Switzerland
Background: Morbidity and mortality are continuously decreasing after major hepatic surgery due to more advanced operative methods and perioperative care. The extent and indications of liver resections (LR) are being pushed to the limits. As survival increases post-hepatectomy, quality of life (QOL) becomes a leading issue. Up until now, no studies address potential differences in long-term QOL in patients necessitating LR for benign or malignant conditions. Our aim was to see how postoperative diagnosis affected long-term self estimated QOL and health.
Methods: Patients eligible for QOL analysis were selected from our prospectively collected database. Long-term QOL was evaluated based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30, Version 3.0) questionnaire and the liver-specific QLQ-LMC21 module with 51 questions addressing 5 functional and 3 symptom scales. EORTC scores and clinical variables such as malignant versus benign diseases, age or extent of LR were analyzed to identify factors influencing overall QOL. Statistical analysis included the Wilcoxon rank-sum test and a cumulative logistic regression model.
Results: Between 2002-2006, 249 patients had hepatic surgery in our institution. Interventions were carried out in 76% for malignant and 24% for benign conditions and ranged from segmental resections to extended hemihepatectomies. 134 patients were contacted for further QOL analysis after a mean of 26.5 months (± 16.2). There was no statistical difference in the global QOL and health scores between patients with malignant and benign diseases (p=0.367) with an estimated odds ratio of 0.745 (95% CI 0.396-1.399). Note that the 95% confidence interval covers the value 1. Neither the extent of the resection (> 2 segments versus < 2 segments) (p=0.975, OR 0.988, 95% CI 0.461-2.119) nor age significantly influenced over QOL and health and (p= 0.092).
Conclusions: Contrary to general expectations, overall long-term QOL is surprisingly high in patients requiring LR for malignant diseases. Although patients with malignant conditions tended to fare worse within certain sub-group analyses, it is reasonable to conclude that patients with malignant and benign diseases have a similar QOL, although no p-value can be associated with this statement.A worse clinical prognosis does not correlate with a low QOL as judged in the eyes of the patient. For selected patients, “palliative liver resections” may be warranted. However, we are currently monitoring extended hepatic surgery and its associated QOL in a prospective trial with preoperative, short and long-term QOL assessment.
