Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
Ann Surg Oncol. 2021 Aug;28(8):4216-4224. doi: 10.1245/s10434-021-09853-8. Epub 2021 Mar 27.
Long-term pancreatoduodenectomy (PD) survivors have previously reported favorable quality of life (QoL). However, there has been a paucity of studies utilizing pancreas-specific modules for QoL assessment, which may uncover disability that general modules cannot detect.
The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-PAN26 questionnaires were administered to PD survivors who were at least 5 years out of their operations for neoplasms (1998-2011, study cohort) and compared their scores with published preoperative scores of patients with pancreatic cancer (control cohort). The 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 1266 patients who underwent PD, there were 305 survivors with valid contact information, of whom 248 responded to the questionnaire (response rate 81.3%) and made up the study cohort. The median follow-up was 9.1 years (range 5.1-21.2 years). When compared with the control cohort, patients in the study cohort reported higher pancreatic pain (41.7 ± 17.6 vs. 18.1 ± 20.5, p < 0.001, CR large), sexuality dissatisfaction (63.0 ± 37.5 vs. 35.1 ± 34.3, p < 0.001, CR large), altered bowel habits (37.6 ± 30.6 vs. 20.0 ± 24.5, p < 0.001, CR moderate), and digestive symptoms (26.3 ± 29.5 vs. 18.7 ± 27.8, p = 0.002, CR small) scores. There was a higher prevalence of bloating, indigestion, and flatulence, but lower prevalence of future health worry (71.7% vs. 89.6%, p < 0.001) and limitation in planning activities (30.1% vs. 48.3%, p < 0.001) at 5 years.
While post-PD patients had better long-term global QoL than healthy controls, a more granular, pancreas-specific questionnaire uncovered digestive abnormalities and sexuality dissatisfaction. These data can better inform clinical decision making and provide potential areas for improvement and patient support.
长期接受胰十二指肠切除术（PD）的幸存者先前报告了良好的生活质量（QoL）。然而，利用胰腺特异性模块进行 QoL 评估的研究很少，这可能会发现一般模块无法检测到的残疾。
对至少 5 年（1998-2011 年）接受过肿瘤手术的 PD 幸存者进行欧洲癌症研究与治疗组织（EORTC） QLQ-C30 和 QLQ-PAN26 问卷评估，并将其得分与术前胰腺患者的发表得分（对照组）进行比较。差异的临床相关性（CR）根据临床重要差异的验证解释分为小（5-10）、中（10-20）或大（>20）。
在 1266 名接受 PD 的患者中，有 305 名幸存者有有效的联系方式，其中 248 名对问卷做出了回应（回应率为 81.3%），并组成了研究队列。中位随访时间为 9.1 年（范围 5.1-21.2 年）。与对照组相比，研究队列中的患者报告的胰腺疼痛更高（41.7±17.6 与 18.1±20.5，p<0.001，CR 大）、性满意度降低（63.0±37.5 与 35.1±34.3，p<0.001，CR 大）、肠道习惯改变（37.6±30.6 与 20.0±24.5，p<0.001，CR 中）和消化症状（26.3±29.5 与 18.7±27.8，p=0.002，CR 小）评分。腹胀、消化不良和呃逆更为常见，但对未来健康的担忧（71.7%与 89.6%，p<0.001）和活动计划受限（30.1%与 48.3%，p<0.001）的发生率较低。
尽管 PD 后患者的总体长期 QoL 优于健康对照组，但更精细的胰腺特异性问卷揭示了消化异常和性满意度降低。这些数据可以更好地为临床决策提供信息，并为改善和患者支持提供潜在领域。
