Clinical and Patient-Reported Outcomes After Pancreatoduodenectomy for Different Diseases

Pezzilli, Raffaele; Falconi, Massimo; Zerbi, Alessandro; Casadei, Riccardo; Valli, L.; Varale, R; Armatura, Giulia; Felicani, Cristina; Morselli-Labate, Antonio Maria

doi:10.1097/mpa.0b013e318216f693

Cited by 55 publications

(54 citation statements)

References 22 publications

(14 reference statements)

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“…Fortunately, the development of surgical expertise and centralization of pancreatic surgeries in high-volume centers has resulted in a steep decline of mortality rates, from the 25 % reported in the initial series of the 1960s to the current rate of less than 3 % [16,17], although with still a consistent gap between high-volume and lowvolume centers [12,16,[18][19][20]. As the survival of these patients has increased because of new chemotherapy strategies for cancer patients [21•, 22], attention has shifted to quality of life [23][24][25][26][27]. Among the possible complications of pancreatic surgery, diabetes mellitus certainly ranks high because of high prevalence [28•, 29•], likelihood of acute events (i.e., hypoglycemic episodes) [30], and long-term complications (i.e., nephropathy, neuropathy and retinopathy) [31][32][33][34][35][36][37][38][39][40], which today, patients are more likely to experience because of increased life expectancy after pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Diabetes After Pancreatic Surgery: Novel Issues

et al. 2015

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In the developed world, pancreatic surgery is becoming more common, with an increasing number of patients developing diabetes because of either partial or total pancreatectomy, with a significant impact on quality of life and survival. Although these patients are expected to consume increasing health care resources in the near future, many aspects of diabetes after pancreatectomy are still not well defined. The treatment of diabetes in these patients takes advantage of the therapies used in type 1 and 2 diabetes; however, no specific guidelines for its management, both immediately after pancreatic surgery or in the long term, have been developed. In this article, on the basis of both the literature and our clinical experience, we address the open issues and discuss the most appropriate therapeutic options for patients with diabetes after pancreatectomy.

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Section: Introductionmentioning

confidence: 99%

Diabetes After Pancreatic Surgery: Novel Issues

et al. 2015

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“…The quality of life (QoL) of the patients in the wait-and-see strategy group was assumed to be equal to that of the general population, including reduction related to ageing [21]. Utilities (QoL) after pancreatic surgery were obtained from the pertinent literature [22,23]. All costs and utilities were discounted at a real annual rate of 3% to adjust for the relative value of the euro at present.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Cost-Effectiveness of Immediate Surgery versus a Wait-and-See Strategy for Sporadic Nonfunctioning T1 Pancreatic Endocrine Neoplasms

et al. 2014

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Background: Whether patients with small (<2 cm), sporadic nonfunctioning pancreatic endocrine tumors (NF-PETs) should directly undergo pancreatic surgery or should be followed longitudinally to detect growth and malignancy still has to be defined. Study Design: Based on the pertinent literature of the past decade, a Markov model was developed to investigate this issue. In the wait-and-see strategy arm, surgery was performed if the tumor attained a size ≥2 cm or surpassed 20% of the initial size. In a Monte Carlo probabilistic analysis, 100 hypothetical patients undergoing a wait-and-see strategy were compared to 100 patients directly undergoing surgery, with the aim of investigating the efficacy and cost-effectiveness of the two strategies. Results: During the postdiagnostic lifetime, 63 NF-PETs in the wait-and-see group showed significant growth and underwent surgery: 38 were stage I, 10 were stage II, 15 were stage III and none were stage IV. In the base-case scenario, the mean life expectancy and quality-adjusted life expectancy were found to be superior after immediate surgery [26.1 years and 11.8 quality-adjusted life years (QALYs)] than with the wait-and-see strategy (22.1 years and 8.3 QALYs) as the consequence of ageing during the wait-and-see follow-up which increased mortality due to surgery, when surgery was needed. The model was sensitive to starting age and length of follow-up; in particular, for patients >65 years of age, the two strategies provided similar results but the wait-and-see strategy was more cost-effective. Conclusions: The wait-and-see strategy for NF-PETs <2 cm represents a reasonable approach in patients over 65 years of age; otherwise, immediate surgery is preferable.

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“…Thus, we undertook a multicenter prospective study to evaluate, over a 24-month follow-up, the clinical outcomes and the PROs of patients who consecutively underwent PHR over a 1-year period in order to identify which parameters were probably linked to their QoL. One hundred and ninety-seven patients with benign and malignant pathologies who underwent PHR were studied [49]. A dedicated clinical form and the EORTC QLQ C-30 were administered at evaluation times (immediately before surgery and 6, 12, 18, and 24 months after discharge).…”

Section: Pancreatic Head Resectionmentioning

confidence: 99%

Pancreatic Diseases: The Need to Assess the Quality of Life Raffaele Pezzilli

Pezzilli¹

2012

Pancreat Disorders Ther

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The patient's overall well-being and ability to function is one of the measures capable of quantifying the impact of disease and treatment. Health-related quality of life, as subjectively perceived by the patient, is becoming a major issue in the evaluation of any therapeutic intervention, mainly in patients with chronic diseases. In this paper, the literature regarding the well-being of patients with pancreatic diseases, both acute and chronic, and of patients who undergo surgery for their benign or malignant pancreatic disease will be reviewed. The conclusions that can be drawn from the studies reviewed are that the quality of life should be routinely assessed for evaluating patients with pancreatic diseases.

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Clinical and Patient-Reported Outcomes After Pancreatoduodenectomy for Different Diseases

Abstract: The QoL before PHR was impaired in study patients before resection as compared with the normative population, whereas in patients who survived resection, it significantly improved in the 24 months after surgery.

Cited by 55 publications

References 22 publications

Diabetes After Pancreatic Surgery: Novel Issues

Diabetes After Pancreatic Surgery: Novel Issues

Efficacy and Cost-Effectiveness of Immediate Surgery versus a Wait-and-See Strategy for Sporadic Nonfunctioning T1 Pancreatic Endocrine Neoplasms

Pancreatic Diseases: The Need to Assess the Quality of Life Raffaele Pezzilli

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