TY - JOUR
T1 - Systematic review of functional outcome and quality of life after total pancreatectomy
AU - on behalf of the Dutch Pancreatic Cancer Group
AU - Scholten, L.
AU - Stoop, T. F.
AU - del Chiaro, M.
AU - Busch, O. R.
AU - van Eijck, C.
AU - Molenaar, I. Q.
AU - de Vries, J. H.
AU - Besselink, M. G.
AU - Molenaar, Quintus I.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking. Methods: A systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005–2018). Endpoints included functional outcome and QoL. Results: A total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow-up of 20·8 (range 1·5–96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine-related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes-related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow-up of 15·9 (1·5–96·0) months. Overall QoL, reported by 102 patients with a median follow-up of 28·6 (6·0–66·0) months, using the EORTC QLQ-C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004). Conclusion: Overall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes-related morbidity.
AB - Background: Surgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking. Methods: A systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005–2018). Endpoints included functional outcome and QoL. Results: A total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow-up of 20·8 (range 1·5–96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine-related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes-related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow-up of 15·9 (1·5–96·0) months. Overall QoL, reported by 102 patients with a median follow-up of 28·6 (6·0–66·0) months, using the EORTC QLQ-C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004). Conclusion: Overall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes-related morbidity.
UR - http://www.scopus.com/inward/record.url?scp=85072117232&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/bjs.11296
DO - https://doi.org/10.1002/bjs.11296
M3 - Review article
C2 - 31502658
SN - 0007-1323
VL - 106
SP - 1735
EP - 1746
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 13
ER -