Bypass Surgery Versus Palliative Pancreaticoduodenectomy in Patients with Advanced Ductal Adenocarcinoma of the Pancreatic Head, with an Emphasis on Quality of Life Analyses
| Autor: | Juergen Tepel, Roland Kurdow, Bernd Kremer, Bodo Schniewind, Beate Bestmann, Fred Faendrich, Thomas Kuechler, Doris Henne-Bruns |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Palliative care medicine.medical_treatment Pancreaticoduodenectomy Quality of life Surgical oncology Pancreatic cancer mental disorders medicine Humans Postoperative Period Prospective Studies Prospective cohort study Survival rate Aged business.industry General surgery Palliative Care Middle Aged Biliopancreatic Diversion medicine.disease nervous system diseases Surgery Pancreatic Neoplasms Survival Rate Oncology Bypass surgery Quality of Life Female business Carcinoma Pancreatic Ductal |
| Zdroj: | Annals of Surgical Oncology. 13:1403-1411 |
| ISSN: | 1534-4681 1068-9265 |
| Popis: | In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL).From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery.Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL.QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated. |
| Databáze: | OpenAIRE |
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