Long-Term Quality of Life after Pancreatic Surgery for Intraductal Papillary Mucinous Neoplasm

Abstract

<b><i>Introduction:</i></b> Intraductal papillary mucinous neoplasms (IPMNs) represent the most common precancerous cystic lesions of the pancreas. The aim of our study was to investigate if resection for non-invasive IPMNs alters quality of life (QoL) in a long-term follow-up. <b><i>Methods:</i></b> Patients (<i>n</i> = 50) included in the analysis were diagnosed and resected from 2010 to 2016. QoL was assessed at a median of 5.5 years after resection. At that point in time, the current QoL as well as the QoL before resection was evaluated retrospectively. The standardised European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Pancreatic Cancer (EORTC QLQ – PAN26) was applied for the QoL assessment. <b><i>Results:</i></b> After a median of 66 months postoperatively, the total QoL score significantly worsened (92.13 vs. 88.04, <i>p</i> = 0.020, maximum achievable score = 100) for patients (median age at surgery 68.0 years), mostly due to digestive symptoms. During the same follow-up period, median Eastern Cooperative Oncology Group (ECOG) performance status did not worsen (<i>p</i> = 0.003). <b><i>Conclusions:</i></b> Long-term QoL statistically significantly worsened after pancreatic resection for IPMN. The extent of worsening, however, was small, and QoL still remained excellent. Therefore, resection in cases of IPMN is appropriate, if indicated carefully.

The additive value of CA19.9 monitoring in a pancreatic cyst surveillance program

“…[17][18][19] Moreover, in the current study, 45% of operated individuals underwent surgery for benign disease, while we know that pancreatic surgery is associated with substantial grade III-IV (Clavien-Dindo) morbidity (4%-31%) and mortality (2%-6%). [20][21][22][23][24] We found CA19.9 levels >37 kU/L not to be associated with the (2020) 10 and others. Ciprani et al 10 proposed 100 kU/L as a new cutoff, which would alter the sensitivity and specificity for PC detection from 41% to 85% (cutoff 37 kU/L), to 23% and 97%.…”

“…Also, we established that this often leads to an intensified follow‐up regimen, which could cause harm due to unnecessary diagnostic procedures (such as EUS/FNA) and psychological distress 17–19 . Moreover, in the current study, 45% of operated individuals underwent surgery for benign disease, while we know that pancreatic surgery is associated with substantial grade III‐IV (Clavien‐Dindo) morbidity (4%–31%) and mortality (2%–6%) 20–24 …”

Quality of Life and Gastrointestinal Symptoms in Long-term Survivors of Pancreatic Cancer Following Pancreatoduodenectomy

“…5,6 Prior analyses have primarily focused on pancreatic resections for benign pathologies and have shown that QOL worsens in the acute postoperative period. 7,8 However, there is a paucity of long-term QOL data, especially for patients undergoing surgery for pancreas cancer. [7][8][9] As surgery is currently the only known treatment that offers long-term survival for pancreatic cancer, a thorough understanding of posttreatment QOL and any potential longterm GI symptoms may guide patient-centered care discussions.…”

“…The diagnosis and treatment of pancreatic cancer carry significant emotional, physical, and social costs 5,6 . Prior analyses have primarily focused on pancreatic resections for benign pathologies and have shown that QOL worsens in the acute postoperative period 7,8 . However, there is a paucity of long-term QOL data, especially for patients undergoing surgery for pancreas cancer 7–9 .…”

Comment on “Surgery for Intraductal Papillary Mucinous Neoplasms of the Pancreas: Preoperative Factors Tipping the Scale of Decision-Making”

“…In addition, consideration of recurrence and long-term survival after surgery for IPMN, TP, and PD might have different operation indications. 2 , 3 Therefore, we think the authors should respectively provide predictors of severe surgical complications and a classification tree for PD and TP.…”