Quality of Life After Treatment for Pancreatitis

Abstract

ObjectiveThe authors evaluated the morbidity, mortality, and quality of life after pancreatic debridement for necrosis and compared these values to those for quality of life after elective medical and surgical management for chronic pancreatitis. Summary Background DataQuality of life after pancreatic debridement for necrosis has received little attention. Although quality of life after other pancreatic surgery has been evaluated and is thought to be good, management of patients with pancreatic necrosis can be labor intensive and require extraordinary resources. Therefore, further evaluation of the quality of life achieved after treatment is appropriate. MethodsForty patients (group 1) underwent operative debridement for necrosis between 1986 and 1994. Medical records of these patients were reviewed for morbidity, mortality, and in-hospital costs. Follow-up of quality of life was assessed by the Short Form-36 Health Survey. Patients in group 2 (n = 89) underwent medical management of chronic pancreatitis. Group 3 included 47 patients who underwent elective operations for ductal abnormalities. The Short Form-36 Health Surveys were administered to all three groups and compared statistically. ResultsMortality and morbidity from pancreatic debridement was 18% and 77%, respectively. Quality-oflife evaluations in groups 1 through 3 and age-matched controls were statistically similar. ConclusionsPancreatic debridement for necrosis requires intense application of resources and is associated with a high mortality and morbidity. Long-term follow-up shows good quality of life for patients who survive this morbid disease. This study supports the continued aggressive approach to the management of pancreatic necrosis, given that long-term outcome about quality of life is good. outcome is expected. In patients with infected necrosis and managed without surgery, the mortality approaches 100%.1-3 After surgical treatment, patient mortality has ranged from 9% to 40%, with the highest mortality associated with infected necrosis.4-6 Morbidity approaches 100% in these patients who require operative debridement.7 With improvement in intensive care medicine and supportive care over the past 2 to 3 decades, mortality has improved and the majority ofthese patients, even 665

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

“…In our study involving Italian patients with chronic pancreatitis [20], neither the type of pancreatic surgery nor endoscopic therapy were able to substantially modify the various physical and mental domains investigated by the SF-36 and this is in contrast to previous studies regarding the various surgical and endoscopic options [4,16,[22][23][24][25][26][27][28][29]; the difference may be due to the fact that these latter studies [4,16,[22][23][24][25][26][27][28][29] enrolled a highly selected group of patients with a short time interval between the intervention and the assessment of the health-related quality of life or that the data were not adjusted for sex and age.…”

“…All these studies regard patients operated on for acute illness and, in the majority of them, the patient's reported outcomes were evaluated only after a long time interval following discharge [3][4][5][6][7][8]. The questionnaires used in these six studies were: the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) in four [4,5,7,8], the Rosser disability and distress index in one [3], and the Karnofsky score, the Rankin score and the Sickness Impact Profile in the remaining one [6]. In one study, the patients completed the questionnaire after 1 year [3], whereas, in the other studies, the questionnaires were completed within 3 years after discharge [4][5][6][7][8].…”

“…The questionnaires used in these six studies were: the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) in four [4,5,7,8], the Rosser disability and distress index in one [3], and the Karnofsky score, the Rankin score and the Sickness Impact Profile in the remaining one [6]. In one study, the patients completed the questionnaire after 1 year [3], whereas, in the other studies, the questionnaires were completed within 3 years after discharge [4][5][6][7][8]. While the majority of authors have reported a good quality of life for their patients cured of acute pancreatitis [3][4][5][6][7], others have not [8].…”

“…In one study, the patients completed the questionnaire after 1 year [3], whereas, in the other studies, the questionnaires were completed within 3 years after discharge [4][5][6][7][8]. While the majority of authors have reported a good quality of life for their patients cured of acute pancreatitis [3][4][5][6][7], others have not [8]. Finally, there are no data available on the modification of the patient's reported outcome in medically-treated patients.…”

Changes in the Management of Treatment in Acute Pancreatitis Patients

“…First, necrotic pancreatic tissue as well as pancreatic ascites is removed out of the peritoneal cavity and the lesser sac, to prevent absorption through the thoracic duct, which is accused to increase the incidence of systemic complications as development of single or multiple organ failure (Mayer et al, 1985). Second, as much as possible viable pancreatic tissue should be preserved to insure a good quality of life after recovery (Broome et al, 1996). Nowadays mortality in patients with infected pancreatic necrosis is about 10-30% in specialized centers as a result of right timing and patient selection (Büchler et al, 2000).…”