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Content available remote Quality of Life of Patients Following Pylorus-Sparing Pancreatoduodenectomy
Quality of life after pancreatoduodenectomy (PD) for cancer of the head of the pancreas depends on multiple factors. Handling of the pancreatic remnant is a decisive factor for the success of the operation. The aim of the study is to assess quality of life of patients with cancer of the head of the pancreas undergoing pylorus-sparing PD and reconstruction with pancreaticojejunostomy (PJ) versus pancreaticogastrostomy (PG).Material and methods. An analysis was performed for 115 patients with malignancy of the head of the pancreas who underwent surgical treatment in the Department of Gastrointestinal Surgery Medical Academy of Silesia between 2004 and 2006. Quality of life was assessed with the EORTC QLQ-C30 and QLQ-PAN26 forms. These questionnaires were mailed to 34 patients at least 6 months after PD. The 20 patients who returned correctly completed questionnaires were divided into two groups. Group I included 14 patients after PD with (Traverso or Imanaga) PJ. Group II included six patients after PD with Flautner PG.Results. The study groups were homogeneous with respect to age, gender, preoperative and intraoperative factors, and complications. Better quality of life was observed in group I with respect to the cognitive functions, general fatigue, and insomnia scales., Group II exhibited better quality of life with respect to the physical functioning, social functioning, life activity, general health, dyspeptic symptoms, nausea and vomiting, diarrhea, respiratory disturbances, lack of satisfaction with own appearance, taste changes, liver symptoms, decreased muscle strength, indigestion, dry mouth and treatment of emergent side-effects scales.Conclusions. Patients in the study group following PD and Flautner PG exhibit markedly better quality of life.
Tumors of the pancreas and the pancreatoduodenal area constitute a group characterized by highly variable histological structure and differing prognosis. Adenocarcinoma of the pancreas is the most common tumor of this area and prognosis of patients with this tumor still remains poor.The aim of the study was to present characteristics of tumors of the pancreatoduodenal are and the pancreas in our own material.Material and methods. Since May 2005, a systematic prospective assessment was started of patients with tumors of the pancreas that underwent surgery in Department of Surgery, Clinic of Oncology, Center of Oncology in Warsaw. Within 22 months, between 1.03.2005 and 31.12.2006, 85 patients (42 women, 43 men) with lesions of the pancreas or ampulla of Vater, potentially amenable to resection, were qualified for surgical treatment. An average age of patients that underwent surgery was 61.2 years.Results. Surgical resection was performed in 43 patients (50.6%), including: 17 pancreatoduodenectomies (39.5%), 7 total pancreatectomies (16.3%), 16 peripheral splenopancreatectomies (37.2%) and 3 local resections/lesion extirpation (7%).The most common reasons for refraining from resection included: involvement of mesenteric vessels (12/42 - 28.6%), infiltration of portal vein system (19%), liver metastases (19%).Adenocarcinoma of the pancreas was the predominant histological diagnosis (32/85 - 37.64%), followed by chronic pancreatitis (14.1%). Tumors of uncertain or unknown malignant potential (neuroendocrine tumors, mucinous cystic neoplasm, solid cystic papillary tumor) were diagnosed in 13 patients (15.3%).Conclusions. Despite more and more precise preoperative diagnosis, significant percentage of patients qualified for radical resection of tumors of the pancreas and pancreatoduodenal area, have lesions not amenable to surgical resection. Significant percentage of tumors of uncertain or unknown malignant potential in the presented material must be emphasized. This group of patients requires different management approach than patients with adenocarcinoma.
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