Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Ann Surg. 2018 Oct;268(4):657-664. doi: 10.1097/SLA.0000000000002962.
To perform a comprehensive assessment of long-term quality of life (QOL) and gastrointestinal (GI) function in patients following pancreaticoduodenectomy (PD).
Survival after PD has greatly improved and thus has resulted in a larger population of survivors, yet long-term QOL and GI function after PD is largely unknown.
Patients were identified from a global online support group. QOL was measured using the Short Form-36, while GI function was assessed using the Gastrointestinal Symptom Rating Scale. QOL and GI function were analyzed across subgroups based on time after PD. QOL was compared with preoperative measurements and with established values of a general healthy population (GHP). Multivariate linear regression was used to identify predictors of QOL.
Of the 7605 members of the online support group, 1102 responded to the questionnaire with 927 responders meeting inclusion criteria. Seven hundred seventeen (77.3%) of these responders underwent PD for malignancy. Mean age was 57 ± 12 years and 327 (35%) were male. At the time of survey, patients were 2.0 (0.7, 4.3) years out from surgery, with a maximum 30.7-year response following PD. Emotional and physical domains of QOL improved with time and surpassed preoperative levels between 6 months and 1 year after PD (both P < 0.001). Each GI symptom worsened over time (all P < 0.001). Independent predictors of general QOL in long-term survivors (> 5 years) included total GSRS score [β = -1.70 (-1.91, -1.50)], female sex [β = 3.58 (0.67, 6.46)], and being a cancer survivor [β = 3.93 (0.60, 7.25)].
Long-term QOL following PD improves over time, however never approaches that of a GHP. GI dysfunction persists in long-term survivors and is an independent predictor of poor QOL. Long-term physical, psychosocial, and GI functional support after PD is encouraged.
全面评估胰十二指肠切除术（PD）后患者的长期生活质量（QOL）和胃肠道（GI）功能。
PD 后的生存率有了很大提高，因此存活患者人数也有所增加，但 PD 后长期 QOL 和 GI 功能仍知之甚少。
从全球在线支持小组中确定患者。使用 36 项简短健康调查量表（Short Form-36）测量 QOL，使用胃肠道症状评定量表（Gastrointestinal Symptom Rating Scale）评估 GI 功能。根据 PD 后时间，按亚组分析 QOL 和 GI 功能。将 QOL 与术前测量值和一般健康人群（GHP）的既定值进行比较。使用多元线性回归来确定 QOL 的预测因素。
在在线支持小组的 7605 名成员中，有 1102 名回复了问卷，其中 927 名符合纳入标准的应答者。这些应答者中有 717 名（77.3%）因恶性肿瘤接受 PD。平均年龄为 57±12 岁，327 名（35%）为男性。在调查时，患者距手术时间为 2.0（0.7，4.3）年，PD 后最长随访时间为 30.7 年。PD 后 6 个月至 1 年内，QOL 的情感和身体领域逐渐改善并超过术前水平（均 P <0.001）。每个胃肠道症状随时间恶化（均 P <0.001）。长期幸存者（> 5 年）一般 QOL 的独立预测因素包括总 GSRS 评分[β=-1.70（-1.91，-1.50）]、女性[β=3.58（0.67，6.46）]和癌症幸存者[β=3.93（0.60，7.25）]。
PD 后长期 QOL 随时间改善，但从未达到 GHP 的水平。长期幸存者仍存在胃肠道功能障碍，是 QOL 不良的独立预测因素。鼓励 PD 后提供长期的身体、心理社会和胃肠道功能支持。
