title: Long-term outcomes after total pancreatectomy: special reference to survivors' living conditions and quality of life.
abstract: BACKGROUND
  Although recent studies have confirmed the safety of total pancreatectomy (TP), appropriate selection of patients for TP has not been well documented. Because patients require lifelong medical treatment and self-management of pancreatic insufficiency after TP, indications for TP should be determined carefully according not only to disease factors but also to the social background of patients. We aimed to clarify long-term outcomes after TP, including the living conditions and quality of life (QoL), of surviving patients.
  
  
  METHODS
  Medical records of 44 consecutive patients who underwent TP between 1990 and 2013 were reviewed retrospectively; 25 survivors completed cross-sectional clinical surveys and responded to a questionnaire about QoL using Short Form 36v2.
  
  
  RESULTS
  Prevalence of morbidity and mortality after TP was 32 and 5 %, respectively. Postoperative complications occurred more frequently in elderly patients than in young patients (48 vs. 14 %; P = 0.02); however, there was no significant difference in mortality, postoperative hospital stay, or survival. Twenty-four of 25 survivors (96 %) could manage pancreatogenic diabetes by themselves, and the median level of glycosylated hemoglobin was 7.4 %. Although one-third of patients after TP complained of diarrhea and the QoL scores of patients with diarrhea were lower than those of patients without diarrhea, QoL scores after TP were virtually comparable with those of the national population, even in elderly patients.
  
  
  CONCLUSIONS
  TP can be performed safely, even in elderly patients. QoL after TP seems to be acceptable if patients are capable of self-management.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, wyuusuke@surg1.med.kyushu-u.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Taketo
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Hideyo
authors.initials: H
authors.lastname: Kimura
authors.forename: Koji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyasaka
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Inoguchi
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology* / Q000628:therapy; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D018579:Patient Selection; D011788:Quality of Life; D012111:Residence Characteristics; D012189:Retrospective Studies; D012648:Self Care; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin