*Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA ‡Department of Psychology, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Department of Surgery, University of Southampton, Southampton, UK.
Ann Surg. 2017 Oct;266(4):685-692. doi: 10.1097/SLA.0000000000002380.
Our aim was to assess quality of life (QOL) and functionality in a large cohort of patients ≥5-years after pancreaticoduodenectomy (PD).
Long-term QOL outcomes after PD for benign or malignant disease are largely undocumented.
We administered the EORTC QLQ-C30 questionnaire to patients who underwent PD for neoplasms from 1998 to 2011 and compared their scores with an age- and sex-matched normal population. Clinical relevance (CR) of differences was scored as small (5-10), moderate (10-20), or large (>20) based on validated interpretation of clinically important differences.
Of 305 PD survivors, 245 (80.3%) responded, of whom 157 (64.1%) underwent PD for nonmalignant lesions. Median follow-up was 9.1 years (range 5.1 -21.2 yrs). New-onset diabetes developed in 10.6%; 50.4% reported taking pancreatic enzymes; 54.6% reported needing antacids. Compared with the age- and sex-adjusted controls, PD survivors demonstrated higher global QOL (78.7 vs 69.7, CR small, P < 0.001), physical (86.7 vs 77.9, CR small, P < 0.001) and role-functioning scores (86.3 vs 74.1, CR medium, P < 0.001). Using linear regression and adjusting for socioeconomic variables, there were no differences in QOL or functional scores in the benign versus malignant subgroups. Older age at operation was associated with worse physical-functioning (-0.4/yr, P = 0.008). Taking pancrelipase (-6.8, P = 0.035) or antacids (-6.3, P = 0.044) were both associated with lower social-functioning scores.
Patients who had a PD demonstrated better global QOL, physical- and role-functioning scores at 5-years when compared with age- and sex-matched controls. Approximately half of the patients required pancreatic enzyme replacement, while only 11% developed new-onset diabetes.
我们旨在评估胰腺十二指肠切除术（PD）后≥5 年的大量患者的生活质量（QOL）和功能。
PD 治疗良性或恶性疾病的长期 QOL 结果在很大程度上尚未记录。
我们对 1998 年至 2011 年间因肿瘤而行 PD 的患者进行了 EORTC QLQ-C30 问卷调查，并将其评分与年龄和性别匹配的正常人群进行了比较。根据临床重要差异的验证解释，差异的临床相关性（CR）被评为小（5-10）、中（10-20）或大（>20）。
在 305 名 PD 幸存者中，有 245 名（80.3%）做出了回应，其中 157 名（64.1%）因非恶性病变而行 PD。中位随访时间为 9.1 年（范围为 5.1-21.2 年）。新发糖尿病发生率为 10.6%；50.4%的患者报告服用胰酶；54.6%的患者报告需要抗酸剂。与年龄和性别调整后的对照组相比，PD 幸存者的总体 QOL 更高（78.7 比 69.7，CR 小，P <0.001），身体（86.7 比 77.9，CR 小，P <0.001）和角色功能评分（86.3 比 74.1，CR 中，P <0.001）。使用线性回归并调整社会经济变量后，良性与恶性亚组之间的 QOL 或功能评分没有差异。手术时年龄较大与身体功能较差相关（-0.4/年，P=0.008）。服用胰酶（-6.8，P=0.035）或抗酸剂（-6.3，P=0.044）均与社会功能评分较低相关。
与年龄和性别匹配的对照组相比，接受 PD 的患者在 5 年时的总体 QOL、身体和角色功能评分更高。大约一半的患者需要胰酶替代治疗，而只有 11%的患者出现新发糖尿病。
