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 25 May 2018

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Standard versus radical pancreaticoduodenectomy for periampullary adenocarcinoma

Researchers in the January issue of the Journal of Gastrointestinal Surgery find no differences in long-term quality of life, between standard and radical resection for periampullary adenocarcinoma.

News image

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Pancreaticoduodenectomy is increasingly performed for periampullary adenocarcinoma. However, the appropriate extent of resection (standard versus radical) remains controversial, particularly with respect to survival benefit.

Past reports have suggested that radical resection is attended by negative functional outcomes and poorer health-related quality of life (QOL). This diminishes any possible survival advantage of the radical resection.

In this study, researchers from Baltimore, Maryland, assessed the QOL of patients who were randomly allocated to 1 of 2 treatments. Patients received either standard, or radical pancreaticoduodenectomy, for periampullary adenocarcinoma.

The research team performed a prospective, randomized single-institution trial. They compared standard and radical pancreaticoduodenectomy in 299 patients, between 1996 and 2001.

A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey, designed for hepatobiliary cancer, was sent to 150 of the 299 patients.

QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being.

The team analyzed 105 of the surveys. The team randomized 55 of the patients the standard group, and 50 to the radical group.

The patients were evaluated at a mean of 2.2 years after pancreaticoduodenectomy.

The quality of life survey scores were similar between the groups.
Journal of Gastrointestinal Surgery
The research team found that the 2 groups were statistically similar with regard to multiple parameters. These included age at operation, race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications.

However, the radical group had a significantly higher percentage of men (66% versus 44%), a longer operative time, and a longer postoperative length of hospital stay.

The team determined that the FACT-Hep total QOL scores were similar between both groups.

In addition, subscale scores evaluating physical, social, emotional, and functional well-being were comparable between the standard and radical groups.

The team found that subgroup analyses based on pathologic diagnosis failed to reveal any differences in QOL assessment between the groups.

Furthermore, QOL measures were similar when comparing time since operation and age.

Dr Tom Nguyen's team concluded, "This is the largest report comparing QOL assessment in survivors of pancreaticoduodenectomy randomized between standard and radical resection".

"These data demonstrate no differences in long-term QOL between standard and radical resection."

"These results imply that no negative long-term QOL measures are associated with radical pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma."

J Gastrointest Surg 2003; 7: 1-11
28 January 2003

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