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Quality of Life After Total Pancreatectomy: Is It Really That Bad on Long-Term Follow-Up?
Brian J. Billings, John D. Christein, Mayo Clinic College of Medicine, Rochester, MN; William S. Harmsen, Mayo Clinic, Rochester, MN; Florencia G. Que, Michael B. Farnell, David M. Nagorney, Michael Sarr, Mayo Clinic College of Medicine, Rochester, MN

While selected pancreatic diseases may be best treated by total pancreatectomy (TP), many surgeons believe the anticipated sequelae of pancreatic insufficiency and erratic glycemic control make TP an undesirable alternative. AIM: To determine long-term health-related quality-of-life (QoL) and glycemic control by validated surveys in patients more than 2 years after a TP.

HYPOTHESIS:
Patients undergoing a TP, with no evidence of recurrent disease (NED), have a worse quality of life than normals and specifically a worse long-term glycemic control than patients with diabetes from other causes.

METHODS:
After reviewing hospital morbidity and mortality of all 97 patients undergoing TP from 1985-2002, we surveyed all 34 survivors who were NED with the Short Form-36 (SF-36), the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC PAN 26), and the Audit of Diabetes Dependent QoL (ADD QoL), all validated instruments, and our own questionnaire.

RESULTS:
Of all the 97 patients undergoing TP, 78% had malignant disease and 22% had benign disease. Hospital morbidity rate for all patients was 26%--2 required reoperation. The 30-day mortality was 3%. 27 of 34 patients (81%) returned the questionnaires, of whom 7 (26%) had benign and 20 (74%) had malignant pancreatic pathology. Scoring of the SF-36 revealed patients' perceived health after TP by 6 of 8 domains was not significantly different from normals. Two domains, the Role Physical and General Health, were however decreased (p<0.04). Likewise, review of the ADD QoL showed that the average weighted impact score (xSD) of -1.51.7 was decreased from the mean of other diabetics (score 0.0, p<0.001). In the surveyed group, 8 patients required hospitalization for hypoglycemia (n=2) or hyperglycemia (n=6), giving a risk of hospitalization for glycemic problems of 0.4. However, when the 63 non-survivors were reviewed, 3 deaths (3%) were directly attributable to hypoglycemia. Analysis of the EORTC-PAN 26 instrument is not yet complete.

SUMMARY:
Total pancreatectomy can be performed safely with higher but acceptable perioperative morbidity and mortality than pancreatoduodenectomy. QoL after TP is less than controls as measured by validated instruments.

CONCLUSIONS:
Total pancreatectomy is an option for treating pancreatic pathology when indicated, but long-term effects of TP on QoL especially related to diabetes are appreciable.


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