Long-term Functional Outcome after Pancreatoduodenectomy

Choi, Min Gew; Kim, Sun Whe; Jang, Jin Young; Yoon, Yoo Seok; Park, Yong Hyun

Abstract

PURPOSE
Recent decreases in operative mortality haves made pancreaticoduodenectomy (PD) a routine surgical procedure for malignant and even benign diseases of the periampullary region. However, as But the procedure requires resection of multiple organs and reconstruction of the digestive tract and, therefore, it may lead to a variety of problems after operation. In the present study, the long-term outcomes of gastrointestinal (GI) function and quality of life (QOL) after PD were assessed. METHODS: The subjects were 78 patients who underwent PD during the period from 1996 to 2000 and survived more than 3 years without clinical evidence of recurrence. General nutritional status, the exocrine and endocrine function of the pancreas, GI symptoms and QOL were assessed. The mean follow-up duration was 58.8 months. RESULTS: There were 45 men and 33 women, with athe mean age of 54.8 years. The indications for PD were ampulla of Vater cancer in 35 patients (44.9%), common bile duct cancer in 20 patients (25.6%), pancreatic head cancer in 4 patients (5.1%), duodenal cancer in 3 patients (3.8%), gallbladder cancer in 1 patients (1.3%) and benign diseases in 15 patients (19.2%). Pylorus preserving pancreatoduodenectomy (PPPD) was performed in 63 cases (80.8%) and Whipple"s operation in the other 15 cases (19.2%). After PD, overall body weight decreased significantly compared to preoperative body weight (p< 0.05) but remained above the ideal body weight. Steatorrhea adversely affected postoperative body weight recovery adversely. The serum protein and albumin recovered to more than their preoperative levels after 6 months postoperatively. Excluding 15 patients with preexisting impaired fasting glucose (IFG) or diabetes mellitus (DM), IFG or DM newly developed in 18 of 63 (28.5%) patients after operation and steatorrhea was significantly related. Steatorrhea developed in 20 cases (25.6%) and associated factors were the development of DM, pancreaticogastrostomy and being aged ages under 60 (p< 0.05). The most troubling GI symptoms were increased flatus (28.8%), hard stools (16.7%) and sucking sensation (11.9%). The score for the global health status / QOL was 73.7% and was not very so much different from the reference value of the general population (75.3%). CONCLUSION: Long-term outcomes of GI functions and QOL after PD were generally favorable. However, But DM and steatorrhea due to pancreas atrophy has developed not rather infrequently and so, early detection and careful management of these are required after PD.