title: Quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection.
abstract: BACKGROUND
  Quality of life after total pancreatectomy (TP) is perceived to be poor secondary to insulin-dependent diabetes and pancreatic insufficiency. As a result, surgeons may be reluctant to offer TP for benign and premalignant pancreatic diseases.
  
  
  METHODS
  We retrospectively reviewed presenting features, operative characteristics, and postoperative outcomes of all patients who underwent TP at our institution. Quality of life was assessed using institutional questionnaires and validated general, pancreatic disease-related, and diabetes-related instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30 and module EORTC-PAN26], Audit of Diabetes Dependent Quality of Life), and compared with frequency-matched controls, patients after a pancreaticoduodenectomy (PD). Continuous variables were compared using Student t-test or analysis of variance. Categorical variables were compared using χ(2) or Fisher exact test.
  
  
  RESULTS
  Between 1994 and 2011, 77 TPs were performed. Overall morbidity was 49%, but only 15.8% patients experienced a major complication. Perioperative mortality was 2.6%. Comparing 17 TP and 14 PD patients who returned surveys, there were no statistically significant differences in quality of life in global health, functional status, or symptom domains of EORTC QLQ-C30 or in pancreatic disease-specific EORTC-PAN26. TP patients had slightly but not significantly higher incidence of hypoglycemic events as compared with PD patients with postoperative diabetes. A negative impact of diabetes assessed by Audit of Diabetes Dependent Quality of Life did not differ between TP and PD. Life domains most negatively impacted by diabetes involved travel and physical activity, whereas self-confidence, friendships and personal relationships, motivation, and feelings about the future remained unaffected.
  
  
  CONCLUSIONS
  Although TP-induced diabetes negatively impacts select activities and functions, overall quality of life is comparable with that of patients who undergo a partial pancreatic resection.
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: irene.epelboym@gmail.com.
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Megan
authors.initials: M
authors.lastname: Winner
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: DiNorcia
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Minna K
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Beth
authors.initials: B
authors.lastname: Schrope
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: Chabot
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: jallendorf@winthrop.org.
authors.forename: John D
authors.initials: JD
authors.lastname: Allendorf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010180:Pancreatectomy / Q000379:methods* / Q000523:psychology* / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology / Q000523:psychology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Pancreatic cancer; Quality of life; Total pancreatectomy