Prophylactic Pancreatic Resection in Patients with Ipmn Does Not Negatively Impact Patient Quality of Life: a Preliminary Study
Minna K. Lee*, Joseph Dinorcia, Marc M. Holden, Lisa J. Pursell, Wei-Yann Tsai, Peter D. Stevens, Nicole Goetz, Victor R. Grann, John a. Chabot, John D. Allendorf
Surgery, Columbia University College of Physicians and Surgeons, New York, NY
Background Intraductal papillary mucinous neoplasm (IPMN) is a well-characterized, mucin-producing cystic lesion of the pancreas with clear malignant potential. Uncertainties remain over whether prophylactic surgery or surveillance is the better treatment option. To date, there is little data to help guide patients and physicians who are deciding between surgery and surveillance for IPMN.Objective The aim of this pilot study was to determine if differences in anxiety and quality of life exist between patients with IPMN who have prophylactic surgery and those who undergo surveillance.Methods We recruited patients with IPMN diagnosed in the past 12 months who either had prophylactic surgery or are undergoing a surveillance protocol that includes yearly magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) staggered every 6 months. These patients were given the HADS questionnaire, a general survey that evaluates anxiety, and the FACT-Pa questionnaire, a pancreatic disease-specific survey that assesses quality of life via four primary domains (physical well-being, emotional well-being, social well-being, and functional well-being). These validated questionnaires were scored by a standardized algorithm and compared using unpaired t-test.Results We identified 20 patients who had prophylactic surgery and 11 patients who are undergoing a surveillance protocol for IPMN. The mean age of the patients was 66.8 +/- 19.9 years, with 55% being female. Of those patients who underwent resection, pancreaticoduodenectomy was performed in 10, distal pancreatectomy in 4, central pancreatectomy in 2, and total pancreatectomy in 3. Patient responses from both groups were remarkably similar. Patients in the surgery group scored higher on the anxiety questionnaire than the surveillance patients, although this difference did not reach statistical significance (p=0.14). Patients in the surgery group scored lower on the functional well-being domain of the FACT-Pa questionnaire (p=0.04), though there were no significant differences in the other quality of life domains (physical well-being, p=0.27; social well-being, p=0.68; emotional well-being, p=0.48). There were no significant differences between the two groups in overall quality of life as assessed by the FACT-Pa questionnaire (p=0.45). Conclusion Prophylactic surgery does not significantly reduce quality of life in this highly-motivated and health conscious patient population. Furthermore, a protocol of surveillance does not appear to generate undo anxiety in these patients. Further investigation with a larger patient population is required to validate these preliminary findings.
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