A Contemporary Evaluation of the Cause of Death and Long-Term Quality of Life After Total Pancreatectomy

Wenchuan Wu, Rebecca Dodson, Martin A Makary, Matthew J Weiss, Kenzo Hirose, John L Cameron, Nita Ahuja, Timothy M. Pawlik, Christopher Wolfgang, Jin He

Research output: Contribution to journalArticle

Abstract

Objective: Total pancreatectomy (TP) may be considered for diffuse disease of the pancreas. However, the quality of life (QOL) implications of TP have not been well studied in the contemporary era. We report the QOL and cause of death after TP. Methods: 186 patients underwent TP between 2000 and 2013. The 100 who were still alive at last follow-up were sent a questionnaire including the Short Form-36 (SF-36), the Audit of Diabetes Dependent QoL (ADD QoL), and the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC-PAN-26). The cause of death was determined for the 86 patients who were dead at last follow-up. Results: While the majority of deaths of the 86 patients were cancer related (n = 65), only one patient died of diabetes complications. Among the 100 surviving patients, the median follow-up was 5.9 years. Among the 36 patients who responded to the survey, every patient required pancreatic enzymes and insulin; four patients required seven total hospitalizations for hypoglycemia. The SF-36 survey indicated a worse QOL in six domains compared with a national population matched with age and gender. However, only physical and emotional domains were decreased compared with self-matched preoperative state (p <0.01 and p <0.05, respectively). The ADD QoL survey showed an overall decrease in diabetes-related QoL (p <0.01). When compared to other types of insulin-dependent diabetes, no significant difference in QoL were found in 14 of 19 domains. The EORTC-PAN-26 survey demonstrated that more than 50 % of patients had moderate to severe changes in three of seven domains. Conclusions: Mortality from diabetic complications following TP is uncommon. The decreasing QoL after TP is comparable to self-matched preoperative assessment or insulin-dependent diabetes from other causes. Accounting for the overall health changes, TP should be considered in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - May 13 2016

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Pancreatectomy
Cause of Death
Quality of Life
Diabetes Complications
Insulin
Pancreatic Neoplasms
Organizations
Research
Hypoglycemia
Pancreas
Hospitalization
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery

Cite this

A Contemporary Evaluation of the Cause of Death and Long-Term Quality of Life After Total Pancreatectomy. / Wu, Wenchuan; Dodson, Rebecca; Makary, Martin A; Weiss, Matthew J; Hirose, Kenzo; Cameron, John L; Ahuja, Nita; Pawlik, Timothy M.; Wolfgang, Christopher; He, Jin.

In: World Journal of Surgery, 13.05.2016, p. 1-6.

Research output: Contribution to journalArticle

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abstract = "Objective: Total pancreatectomy (TP) may be considered for diffuse disease of the pancreas. However, the quality of life (QOL) implications of TP have not been well studied in the contemporary era. We report the QOL and cause of death after TP. Methods: 186 patients underwent TP between 2000 and 2013. The 100 who were still alive at last follow-up were sent a questionnaire including the Short Form-36 (SF-36), the Audit of Diabetes Dependent QoL (ADD QoL), and the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC-PAN-26). The cause of death was determined for the 86 patients who were dead at last follow-up. Results: While the majority of deaths of the 86 patients were cancer related (n = 65), only one patient died of diabetes complications. Among the 100 surviving patients, the median follow-up was 5.9 years. Among the 36 patients who responded to the survey, every patient required pancreatic enzymes and insulin; four patients required seven total hospitalizations for hypoglycemia. The SF-36 survey indicated a worse QOL in six domains compared with a national population matched with age and gender. However, only physical and emotional domains were decreased compared with self-matched preoperative state (p <0.01 and p <0.05, respectively). The ADD QoL survey showed an overall decrease in diabetes-related QoL (p <0.01). When compared to other types of insulin-dependent diabetes, no significant difference in QoL were found in 14 of 19 domains. The EORTC-PAN-26 survey demonstrated that more than 50 {\%} of patients had moderate to severe changes in three of seven domains. Conclusions: Mortality from diabetic complications following TP is uncommon. The decreasing QoL after TP is comparable to self-matched preoperative assessment or insulin-dependent diabetes from other causes. Accounting for the overall health changes, TP should be considered in carefully selected patients.",
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AU - Dodson, Rebecca

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AU - Weiss, Matthew J

AU - Hirose, Kenzo

AU - Cameron, John L

AU - Ahuja, Nita

AU - Pawlik, Timothy M.

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AB - Objective: Total pancreatectomy (TP) may be considered for diffuse disease of the pancreas. However, the quality of life (QOL) implications of TP have not been well studied in the contemporary era. We report the QOL and cause of death after TP. Methods: 186 patients underwent TP between 2000 and 2013. The 100 who were still alive at last follow-up were sent a questionnaire including the Short Form-36 (SF-36), the Audit of Diabetes Dependent QoL (ADD QoL), and the European Organization for Research and Treatment in Cancer Pancreas 26 (EORTC-PAN-26). The cause of death was determined for the 86 patients who were dead at last follow-up. Results: While the majority of deaths of the 86 patients were cancer related (n = 65), only one patient died of diabetes complications. Among the 100 surviving patients, the median follow-up was 5.9 years. Among the 36 patients who responded to the survey, every patient required pancreatic enzymes and insulin; four patients required seven total hospitalizations for hypoglycemia. The SF-36 survey indicated a worse QOL in six domains compared with a national population matched with age and gender. However, only physical and emotional domains were decreased compared with self-matched preoperative state (p <0.01 and p <0.05, respectively). The ADD QoL survey showed an overall decrease in diabetes-related QoL (p <0.01). When compared to other types of insulin-dependent diabetes, no significant difference in QoL were found in 14 of 19 domains. The EORTC-PAN-26 survey demonstrated that more than 50 % of patients had moderate to severe changes in three of seven domains. Conclusions: Mortality from diabetic complications following TP is uncommon. The decreasing QoL after TP is comparable to self-matched preoperative assessment or insulin-dependent diabetes from other causes. Accounting for the overall health changes, TP should be considered in carefully selected patients.

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