Abstracts
1997 Digestive Disease Week

Outcome analysis of long-term survivors following pancreaticoduodenectomy.

WS Melvin, KS Buekers, JA Johnson, WJ Schirmer, EC Ellison. The Department of Surgery, The Ohio State University, Columbus, OH.

The long-term sequalae of pancreaticoduodenectomy (PD) are not completely understood. To help identify potential problems we evaluated long-term survivors of PD for general health, nutritional status and biochemical parameters. Methods: Patients were prospectively followed and individuals were identified who were a minimum of one year following PD and free of malignant disease. The Short Form-36 Health Survey was administered. Physical examinations were performed, which included anthropomorphic measurements for body mass index and Body Impedance Analysis to calculate total body water and lean body mass. Routine blood counts, biochemistries, nutritional parameters and HbA-1c were obtained. Data was compared between age matched controls and patients grouped for type of operation, age, gender and pathology using the Mann-Whitney test. Results: Sixty-one patients in the database were eligible. Forty-five patients completed the survey and 25 underwent physical examination and laboratory testing. There were 24 females and 21 males. Twenty-four patients underwent pylorus preserving pancreaticoduodenectomy (PPPD) and 21 underwent a standard PD. Twenty-seven patients had malignant disease and 18 had benign disease. The mean follow up was 5.5 years with a range of 17-43 months. The SF-36 health survey demonstrated no significant difference in six of the domains of physical and mental health between the subgroups and normal controls. In two domains, General Health and Vitality, significantly lower scores were noted in the subgroup of patients who had undergone a standard PD when compared to a PPPD and to normal. Four patients (16%) were hypoalbuminemic (<3.2g/dl), and three of the four were less than 90% of their ideal body weight. None of the patients had a severe weight deficit. All patients had a normal lymphocyte count and transferrin. Hemoglobin concentrations were below normal in seven patients (28%). An elevated HbA-1c was seen in only one patient who was not diabetic preoperatively. Liver function tests were normal in all patients. Conclusions: Long-term survivors of pancreaticoduodenectomy generally feel as good as their normal counterparts. Standard PD results in some health satisfaction deficits, especially in individual perception of general health and vitality. Protein malnutrition and anemia were common complications and patients should be screened for these abnormalities. Postoperative pancreatic endocrine dysfunction is unusual.