Impact of Post-Operative Complications on Quality of Life After Pancreatectomy

Nsehniitooh Mbah; Russel E Brown; Charles R St. Hill; Matthew R Bower; Susan F Ellis; Charles R Scoggins; Kelly M McMasters; Robert CG Martin

doi:10.6092/1590-8577/617

Nsehniitooh Mbah Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Russel E Brown Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Charles R St. Hill Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Matthew R Bower Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Susan F Ellis Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Charles R Scoggins Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Kelly M McMasters Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA
Robert CG Martin Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine. Louisville, KY, USA

DOI: https://doi.org/10.6092/1590-8577/617

Keywords: Morbidity, Pancreatectomy, Quality of Life

Abstract

Purpose This study was undertaken to analyze the quality of life changes reported by patients with pancreatic cancer undergoing pancreatectomy. Design Post-hoc analysis was performed of a clinical trial examining the safety of intraoperative autotransfusion during oncologic resections. Main outcome measures Perioperative (90-day) complications were graded prospectively using a validated 5-point scale. Quality of life parameters were recorded prospectively by a single trained interviewer preoperatively, at the first post-operative outpatient visit, and at 6 weeks, 3 months, and 6 months follow-up using the EORTC QLQ-C30 and FACT-An instruments. Results Pancreatectomy for adenocarcinoma was performed in 34 patients with a median follow-up of 2 years (range: 1-1.5 years). Major (grade ≥ 3) complications occurred in 12 (35.3%) of patients. Early (<6 month) recurrence was noted in 2 patients (5.9%). Increased severity of fatigue, pain, dyspnea, and loss of appetite over baseline were noted at initial follow-up (P<0.05); however, symptom scores normalized at 6-week follow-up, and remained stable at 6 months. No significant difference was noted in quality of life metrics between patients with or without major complications (P>0.11). A significant (P=0.023) decline in cognitive function vs. baseline was noted at 6-month follow-up after pancreatectomy. Using a repeated-measures generalized linear model, neither age, nor complication occurrence, nor adjuvant therapy, nor early recurrence accounted for this cognitive decline (P>0.10). Conclusion Quality of life metrics tend to normalize to preoperative levels after pancreatectomy at 6 weeks post-operatively. The occurrence of major complications does not predict a decreased quality of life. The decrease in self-reported cognitive function at six months in this cohort merits further study.

Image: FACT physical well-being.

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