Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head

Schniewind, Bodo; Bestmann, Beate; Henne‐Bruns, Doris; Faendrich, Fred; Kremer, Bernd; Kuechler, T.

doi:10.1002/bjs.5371

Cited by 92 publications

(79 citation statements)

References 25 publications

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“…18,23,24,37 We used both the FACT-G and FACT-Hep questionnaires, which have an excellent test-retest reliability, and high internal consistency are easy to complete and have been validated for patients with pancreatobiliary cancers. [23][24][25][26] In addition to the general and disease-specific scores we also evaluated the F-TOI, a functional index that is a sensitive indicator of clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…37,39 In some, various periampullary tumors or pancreatic diseases were considered, 18,21 or HQOL was not assessed longitudinally but only after the therapeutic intervention. 23 Not surprising therefore, our results differ from those previously reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…23 Not surprising therefore, our results differ from those previously reported in the literature. Schniewind et al 37 in a prospective study evaluating HQOL in a group of 91 patients who underwent pancreaticoduodenectomy for pancreatic cancer, showed a large decrease in most HQOL scales after surgery, followed by a slow recovery to preoperative levels. A similar trend was found by Nieveen van Dijkum et al 21 who compared pancreaticoduodenectomy versus biliary and duodenal bypass for pancreatic and periampullary carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…21,23,37 Specifically, missing data can result in overestimation of HQOL since very sick or dying patients are less likely to complete the questionnaires. In our study, this defect might be more prevalent in groups 2 and 3, but it is unlikely that overestimation affected group 1 because the majority of patients were alive with no recurrent disease 3 and 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Crippa

Domínguez

Rodríguez

et al. 2008

Journal of Gastrointestinal Surgery

104

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In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social and functional impairment, and for this reason, health-related quality of life measurements could play an important role in the decision-making process. The aim of this work was to evaluate the quality of life and survival in 92 patients with different stages of pancreatic adenocarcinoma who underwent surgical and/or medical interventions. Patients were evaluated with the Functional Assessment of Cancer Therapy questionnaires at diagnosis and follow-up (3 and 6 months). At diagnosis, 28 patients (30.5%) had localized disease (group 1) and underwent surgical resection, 34 (37%) had locally advanced (group 2), and 30 (32.5%) metastatic disease (Group 3). NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptImprovement in quality of life was found in group 1, while in group 3, it decreased at follow-up (p = 0.03). No changes in quality of life in group 2 were found. Chemotherapy/chemoradiation seems not to significantly modify quality of life in groups 2 and 3. Median survival time for the entire cohort was 9.8 months (range, 1-24). One-year survival was 74%, 30%, and 16% for groups 1, 2, and 3 respectively (p = 0.001). Pancreatic cancer prognosis is still dismal. In addition to long-term survival benefits, surgery impacts favorably quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Crippa

Domínguez

Rodríguez

et al. 2008

Journal of Gastrointestinal Surgery

104

View full text Add to dashboard Cite

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“…A German group conducted a nonrandomized prospective study comparing results after ELND and SL in addition to PD for pancreatic cancer [32][33][34][35]. ELND (n ϭ 70) was the routine procedure and SL (n ϭ 21) was performed in patients with advanced age or comorbidity.…”

Section: Extended Lymph Node Dissectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the evidence in favor of and against the role of surgical resection in the management of pancreatic adenocarcinoma.2. Explain how the components of an extended pancreatectomy, including total pancreatectomy, extended lymph node dissection, and major intestinal arterial resection, do not improve survival above what is provided after pancreaticoduodenectomy and are associated with substantial morbidity.3. Discuss how portal/mesenteric vein resection to achieve negative resection margins does not add to the morbidity of pancreaticoduodenectomy, does not worsen survival after resection, and is most often performed because of tumor location.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAdenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

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Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma

Staerkle

Vuille‐dit‐Bille

Soll

et al. 2021

Cochrane Database of Systematic Reviews

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BACKGROUND Pancreatic and periampullary adenocarcinomas account for some of the most aggressive malignancies, and the leading causes of cancer-related mortalities. Partial pancreaticoduodenectomy (PD) with negative resection margins is the only potentially curative therapy. The high prevalence of lymph node metastases has led to the hypothesis that wider excision with the removal of more lymphatic tissue could result in an improvement of survival, and higher rates of negative resection margins. OBJECTIVES To compare overall survival following standard (SLA) versus extended lymph lymphadenectomy (ELA) for pancreatic head and periampullary adenocarcinoma. We also compared secondary outcomes, such as morbidity, mortality, and tumour involvement of the resection margins between the two procedures. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, and Embase from 1973 to September 2020; we applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCT) comparing PD with SLA versus PD with ELA, including participants with pancreatic head and periampullary adenocarcinoma. DATA COLLECTION AND ANALYSIS Two review authors independently screened references and extracted data from study reports. We calculated pooled risk ratios (RR) for most binary outcomes except for postoperative mortality, for which we estimated a Peto odds ratio (Peto OR), and mean differences (MD) for continuous outcomes. We used a fixed-effect model in the absence of substantial heterogeneity (I² < 25%), and a random-effects model in cases of substantial heterogeneity (I² > 25%). Two review authors independently assessed risk of bias, and we used GRADE to assess the quality of the evidence for important outcomes. MAIN RESULTS We included seven studies with 843 participants (421 ELA and 422 SLA). All seven studies included Kaplan-Meier curves for overall survival. There was little or no difference in survival between groups (log hazard ratio (log HR) 0.12, 95% confidence interval (CI) -3.06 to 3.31; P = 0.94; seven studies, 843 participants; very low-quality evidence). There was little or no difference in postoperative mortality between the groups (Peto odds ratio (OR) 1.20, 95% CI 0.51 to 2.80; seven studies, 843 participants; low-quality evidence). Operating time was probably longer for ELA (mean difference (MD) 50.13 minutes, 95% CI 19.19 to 81.06 minutes; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 88%; P < 0.00001). There may have been more blood loss during ELA (MD 137.43 mL, 95% CI 11.55 to 263.30 mL; two studies, 463 participants; very low-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P = 0.02). There may have been more lymph nodes retrieved during ELA (MD 11.09 nodes, 95% CI 7.16 to 15.02; five studies, 670 participants; moderate-quality evidence). There was substantial heterogeneity between the studies (I² = 81%, P < 0.00001). There was little or no difference in the incidence of positive resection ma...

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Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head

Abstract: The surgical techniques of resection and reconstruction did not affect QoL, but extended lymphadenectomy was associated with an impairment in QoL.

Cited by 92 publications

References 25 publications

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Extended Resection for Pancreatic Adenocarcinoma

Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma

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