Quality of Life After Total Pancreatectomy: Requiem for a Surgical Dogma?
Roberto Salvia*, Silvia Germenia, Stefano Partelli, Stefano Crippa, Claudio Bassi, William Mantovani, Massimo Falconi, Paolo Pederzoli
Department of Surgery, Università di Verona, Verona, Italy
Among pancreatic resections, total pancreatectomy (TP) is generally considered to lead to significant impairments in patients’ quality of life (QoL). Aim of this work was to evaluate QoL and long-term complications in patients undergoing TP at a tertiary referral center. Forty-eight patients undergoing TP between 1994 and 2006 were identified; the 32 survivors (median follow-up 30.5 months) were interviewed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), and with an Institutional questionnaire on pancreatic exocrine-endocrine function. Mortality after surgical resection was zero, and there were no deaths related to the long-term complications. Overall QoL after TP was acceptable (median:5, scale from 1 to 7), despite a slightly decrease compared to the preoperative period (median:6). A significant impairment in QoL was found only in patients with malignancies (P<0.05). Twenty-nine patients (91%) complained of hypoglycemia, 72% of them at least once a week. Steatorrhea and abdominal pain were found in 66% and 44% of patients. Major impairments of leisure and work activities were reported in 56% and 31% of cases. In experienced centers TP is a viable and safe procedure. However TP substantially affects health status, and the risk for long-term complications should be well evaluated; therefore careful patient-selection and long-term follow-up are of paramount importance in this setting.