Department of Surgery, University of Colorado, Aurora, CO, USA.
Department of Surgery, University of Oklahoma, Oklahoma City, OK, USA.
Ann Surg Oncol. 2019 Sep;26(9):2985-2993. doi: 10.1245/s10434-019-07449-x. Epub 2019 Jun 21.
This study was designed to compare quality of life (QoL) among patients who underwent open versus laparoscopic pancreatic resection, including distal pancreatectomy and pancreaticoduodenectomy, and to identify clinical characteristics that are associated with changes in QoL.
Quality of life (QoL) was assessed in patients undergoing pancreatic resection with the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire preoperatively and 2 weeks, 1, 3, and 6 months postoperatively. Multilevel regression modeling was used to determine the variability in each QoL domain within the first 2 weeks (postoperative period) and thereafter (recovery period).
Among 159 patients, 60.4% underwent open and 39.6% underwent laparoscopic surgery. Physical, functional, hepatobiliary, and total QoL scores decreased in the postoperative period but returned to baseline levels by 6 months postoperatively. Emotional QoL improved from baseline by 2 weeks after surgery (p < 0.001) and social QoL improved from baseline by 3 months after surgery (p < 0.001). Emotional QoL was the only domain where significant differences were observed in QoL in the postoperative and recovery periods between patients who underwent open and laparoscopic pancreatic resection. Controlling for surgical approach, patients who experienced a grade III or IV complication experienced greater declines in physical, functional, hepatobiliary, and total QoL in the postoperative period. The negative impact of complications on QoL resolved by 6 months postoperatively.
The impact of pancreatic resection on QoL was comparable between patients who underwent laparoscopic versus open pancreatic resection. Complications were strongly associated with changes in postoperative QoL, suggesting that performing a safe operation is the best approach for optimizing patient reported QoL.
本研究旨在比较行开腹与腹腔镜胰腺切除术（包括胰体尾切除术和胰十二指肠切除术）患者的生活质量（QoL），并确定与 QoL 变化相关的临床特征。
采用肝胆癌症治疗功能评估问卷（Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire）于术前及术后 2 周、1、3、6 个月评估行胰腺切除术患者的 QoL。采用多级回归模型确定前 2 周（术后期间）和之后（恢复期间）各 QoL 域的变异性。
在 159 例患者中，60.4%行开腹手术，39.6%行腹腔镜手术。术后物理、功能、肝胆和总 QoL 评分降低，但术后 6 个月恢复至基线水平。术后 2 周时，情绪 QoL 从基线开始改善（p<0.001），术后 3 个月时社会 QoL 从基线开始改善（p<0.001）。在术后和恢复期间，开腹和腹腔镜胰腺切除术患者的 QoL 在情绪 QoL 方面存在显著差异。控制手术方法后，发生 III 级或 IV 级并发症的患者在术后期间物理、功能、肝胆和总 QoL 下降更为明显。术后并发症对 QoL 的负面影响在术后 6 个月得到解决。
腹腔镜与开腹胰腺切除术对 QoL 的影响在患者之间相当。并发症与术后 QoL 的变化密切相关，这表明安全手术是优化患者报告 QoL 的最佳方法。
