Systematic review of functional outcome and quality of life after total pancreatectomy

Abstract

BackgroundSurgeons 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.MethodsA 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.ResultsA 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).ConclusionOverall 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.

Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision‐making programme using decision tables

“…This will affect a patients’ life substantially and will therefore be emphasised by the surgeon and gastroenterologists, but also extensively discussed during the consult with the diabetes nurse and patient who underwent a total pancreatectomy. A recent systematic review on diabetes mellitus‐related outcomes revealed a need for further improvement of diabetes management after total pancreatectomy, especially regarding the prevention of hypoglycaemia‐related morbidity and even mortality 13 . This study also showed that quality of life seems moderately affected by total pancreatectomy.…”

“…Traditionally, surgeons have been reluctant to perform total pancreatectomy because of postoperative exocrine and endocrine insufficiency, which both worsen quality of life 32 . However, taking into account the improved surgical outcome of total pancreatectomy and the improved treatment of exocrine and endocrine insufficiency, the option to remove the pancreas prophylactically has been brought up by high‐risk individuals and their family members 6 , 12–14 . The PROPAN programme offers a conceptual and informative framework for shared decision‐making in this treatment dilemma.…”

Natural history and optimal treatment strategy of intraductal papillary mucinous neoplasm of the pancreas: Analysis using a nomogram and Markov decision model

“…The survival rate was determined using the Kaplan-Meier method with survival curves compared using the log-rank test. Transitional probabilities, life expectancy, and quality adjusted life year were calculated using cohort data and reviews of peer review data over the past 20 years, [21][22][23][24][25][26][27][28][29] and decision analysis was carried out using decision-analysis software (DATA 4.0; TreeAge Software, Inc.).…”

ASO Author Reflections: The Beneficial Effect of High-Volume Center Experience on Surgical Outcomes After Total Pancreatectomy

“…In recent years, the number of TPs worldwide has increased, since its subsequent endocrine and exocrine insufficiency seems to be better manageable, with an acceptable impact on quality of life. 4 Some ‘new’ pancreatic diseases (i.e. intraductal papillary mucinous neoplasms [IPMNs]) require a TP in some cases in order to achieve curation.…”