Quality of life analysis after Whipple procedure. Retrospective cohort study

Keywords: Pancreaticoduodenectomy, Quality of life, Morbidity, Patient reported outcome measures, Neoplasm

Abstract

Introduction: Patient reported outcomes establish the patient’s own perception about his/her health and enable the development of policies designed to improve health/disease processes. These are particularly helpful in the case of diseases with a significant impact on the patient’s quality of life.

Objective: To compare the quality of life scores assessed using the EQ-5D-5L questionnaire in patients undergoing cephalic duodenopancreatectomy (Whipple procedure) and laparoscopic cholecystectomies in the same hospital.

Methodology: Retrospective cohort trial between July 2018 and February 2020. Patients programmed for cephalic duodenopancreatectomy were included, regardless of the type of pathology, and over 18 years old. Patients with carcinomatosis or vascular infiltration were excluded. The EQ-5D-5L was administered following Whipple surgery and compared against a control group (laparoscopic cholecystectomy). The demographic characteristics, the diagnosis, hospital stay and 60-day mortality were assessed.

Results: A total of 68 patients were included. The most frequent diagnosis was pancreatic cancer (30 %) in the Whipple group and lithiasis (100 %) in the control group. In the five dimensions assessed, there were no differences in terms of mobility (OR: 0.41, 95 % CI [0.30-0.57], p = 0.103) and in terms of personal care (OR: 0.42, 95 % CI [0.32-0.58], p = 0.254). There was a difference in daily life activities (OR: 0.38, 95 % CI [0.27-0.54], p = 0.017), pain/malaise (OR: 2.33, 95 % CI [0.99-5.48]), p = 0.013 and anxiety/depression (OR: 0.39, 95 % CI [0.28-0.55], p = 0.019). The overall health perception was 80 points for Whipple (IQR 60-90) vs. 100 points for the control group (IQR 90-100).

Conclusions: Patients undergoing a Whipple procedure experience a health perception slightly lower than patients undergoing laparoscopic cholecystectomy. This difference may be associated with increased pain, anxiety/depression and a reduction in their activities of daily life. The administration of the EQ-5D-5L questionnaire to measure quality of life is a friendly tool that used be used routinely to plan activities aimed at improving medical care.

References

Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB. 2011;13(6):377-84. doi: http://doi.org/10.1111/j.1477-2574.2011.00305.x.

Xiong J, Szatmary P, Huang W, de la Iglesia-García D, Nunes QM, Xia Q, et al. Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: A PRISMA-compliant systematic review and meta-analysis. Medicine. 2016;95(18):e3497. doi: http://doi.org/10.1097/MD.0000000000003497

Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB. 2015;17(1):11-6. doi: http://doi.org/10.1111/hpb.12265

WHO. Summary Report on proceedings minutes and final acts of the International Health Conference. Int Heal Conf [internet]. 1946;(2):143. Disponible en: http://apps.who.int/iris/bitstream/10665/85573/1/Official_record2_eng.pdf

Nelson EC, Landgraf JM, Hays RD, Wasson JH, Kirk JW. The functional status of patients. How can it be measured in physicians’ offices? Med Care. 1990;28(12):1111-26.

Cruz Bermúdez HF, Moreno Collazos JE, Angarita Fonseca A. Medición de la calidad de vida por el cuestionario QLQ-C30 en sujetos con diversos tipos de cáncer de la ciudad de Bucaramanga-Colombia. Enfermería Global. 2013;12(30):294-303.

Mooney K, Berry DL, Whisenant M, Sjoberg D. Improving cancer care through the patient experience: How to use patient-reported outcomes in clinical practice. American Society of Clinical Oncology Educational Book. 2017;(37):695-704. doi: http://doi.org/10.1200/EDBK_175418

Deshpande P, Sudeepthi Bl, Rajan S, Abdul Nazir C. Patient-reported outcomes: A new era in clinical research. Perspectives Clin Res. 2011;2(4):137. doi: http://doi.org/10.4103/2229-3485.86879

Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman J, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg. 2000;231(6):890-8. doi: http://doi.org/10.1097/00000658-200006000-00014

Mbah N, Brown RE, St. Hill CR, Bower MR, Ellis SF, Scoggins CR, et al. Impact of post-operative complications on quality of life after pancreatectomy. JOP. 2012;13:387-93. doi: http://doi.org/10.6092/1590-8577/617

Rückert F, Distler M, Hoffmann S, Hoffmann D, Pilarsky C, Dobrowolski F, et al. Quality of life in patients after pancreaticoduodenectomy for chronic pancreatitis. J Gastrointestinal Surg. 2011;15(7):1143-50. doi: http://doi.org/10.1007/s11605-011-1539-1

Khan I, Morris S, Pashayan N, Matata B, Bashir Z, Maguirre J. Comparing the mapping between EQ-5D-5L, EQ-5D-3L and the EORTC-QLQ-C30 in non-small cell lung cancer patients. Health Qual Life Outcomes. 2016;14(1):60. doi: http://doi.org/10.1186/s12955-016-0455-1

The EuroQol Group. Certified Translation: EQ-5D-5L Spanish for Colombia. Septiembre de 2012.

Herdman M, Fox-Rushby J, Rabin R, Badia X, Selai C. Producing other language versions of the EQ-5D. En: Brooks R, Rabin R, de Charro F, editors. The measurement and valuation of health status using EQ-5D: A European Perspective. Dordrecht: Springer Netherlands; 2003. p. 183-9. Disponible en: http://link.springer.com/10.1007/978-94-017-0233-1_11. doi: 10.1007/978-94-017-0233-1_11

Browne JP, Cano SJ, Smith S. Using patient-reported outcome measures to improve health care: Time for a new approach. Med Care. 2017;55(10):901-4. doi: http://doi.org/10.1097/MLR.0000000000000792

Osborne NH, Colletti LM. Chapter 15. Pancreaticoduodenectomy. En: Minter RM, Doherty GM, editores. Current Procedures: Surgery [Internet]. New York, NY: The McGraw-Hill Companies; 2010. Disponible en: accesssurgery.mhmedical.com/content.aspx?aid = 65

Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointestinal Surg. 2012;16(9):1727-35. doi: http://doi.org/10.1007/s11605-012-1938-y

Reyna-Sepúlveda F, Muñoz-Maldonado G, Pérez-Rodríguez E, Hernández-Trejo F, Guevara-Charles A, Hernández-Guedea MA. Prognostic factors for survival and surgical complications in Whipple’s pancreatoduodenectomy during a 10-year experience. Cirugía y Cirujanos. 2019;87(2):1233. doi: http://doi.org/10.24875/CIRU.18000526

Laitinen I, Sand J, Peromaa P, Nordback I, Laukkarinen J. Quality of life in patients with pancreatic ductal adenocarcinoma undergoing pancreaticoduodenectomy. Pancreatology. 2017;17(3):445-50. doi: http://doi.org/10.1016/j.pan.2017.02.013

Joshi MR, Bohara TP, Parajuli A, Rupakheti S. Surgeon’s physical and mental stress while performing laparoscopic cholecystectomy. J Kathmandu Med Coll. 2017;4(4):111-7. doi: http://doi.org/10.3126/jkmc.v4i4.18251

Luo K. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol. 2003;9(4):847. doi: http://doi.org/10.3748/wjg.v9.i4.847

Calabro KA, Raval MV, Rothstein DH. Importance of patient and family satisfaction in perioperative care. Seminars in Pediatric Surgery. 2018;27(2):114-20. doi: http://doi.org/10.1053/j.sempedsurg.2018.02.009

Kim S, Duncan P, Groban L, Segal H, Abbott R. Development and implementation of a tool to assess patient-reported outcome measures (PROM) in preoperative setting. Global J Perioperative Med. 2017;1(1):017-21. doi: http://doi.org/10.17352/gjpm.000005

Cabasés JM. El EQ-5D como medida de resultados en salud. Gaceta Sanitaria. 2015;29(6):401-3. doi: 10.1016/j.gaceta.2015.08.007

Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Education. 2017;17(4):137-44. doi: http://doi.org/10.1093/bjaed/mkw060

Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: A randomized controlled trial. J Clin Oncol. 2016;34(6):557-65. doi: http://doi.org/10.1200/JCO.2015.63.0830

Heerkens H, Van Berkel L, J Tseng D, Monninkhof E, Santvoort H, Hagendoorn H, et al. Long-term health-related quality of life after pancreatic resection for malignancy in patients with and without severe postoperative complications. HPB. 2018;20(2):188-95. doi: http://doi.org/10.1016/j.hpb.2017.09.003

Sutton PA, Bourdon‐Pierre R, Smith C, Appleton N, Lightfoot T, Gabriel C, et al. Evaluating unmet needs in patients undergoing surgery for colorectal cancer: a patient reported outcome measures study. Colorectal Disease. 2019;21:797-804. doi: http://doi.org/10.1111/codi.14599

Sinha A, Patel YA, Cruise M, Matsukuma K, Zaheer A, Afghani E, et al. Predictors of post-operative pain relief in patients with chronic pancreatitis undergoing the frey or Whipple procedure. J Gastrointestinal Surg. 2016;20(4):734-40. doi: http://doi.org/10.1007/s11605-016-3081-7

Croome KP, Tee M, Nagorney DM, Truty MJ, Reid-Lombardo Km, Que FG, et al. Pancreatoduodenectomy for chronic pancreatitis—results of a pain relief and quality of life survey 15 years following operation. J Gastrointestinal Surg. 2015;19(12):2146-53. doi: http://doi.org/10.1007/s11605-015-2928-7

Lounis L, Aurran-Schleinitz T, Turrini O, Delpero J-R, Bréjard V. Psychological outcomes and quality of life in relation to pancreatectomy: A systematic review. Pancreas. 2019;48(4):471-9. doi: http://doi.org/10.1097/MPA.0000000000001279

Barnes AF, Yeo TP, Leiby B, Kay A, Winter JM. Pancreatic cancer–associated depression: A case report and review of the literature. Pancreas. 2018;47(9):1065-77. doi: http://doi.org/10.1097/MPA.0000000000001148

Marinelli V, Secchettin E, Andrianello S, Moretti C, Donvito S, Marchegiani G, et al. Psychological distress in patients under surveillance for intraductal papillary mucinous neoplasms of the pancreas: The “Sword of Damocles” effect calls for an integrated medical and psychological approach a prospective analysis. Pancreatology. 2020;20(3):505-10. doi: http://doi.org/10.1016/j.pan.2020.01.006

How to Cite
1.
Aristizábal-Linares JP, Quevedo-Vélez C, Sánchez-Zapata P. Quality of life analysis after Whipple procedure. Retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2020Oct.5 [cited 2020Oct.28];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/946

Downloads

Download data is not yet available.
Published
2020-10-05
How to Cite
1.
Aristizábal-Linares JP, Quevedo-Vélez C, Sánchez-Zapata P. Quality of life analysis after Whipple procedure. Retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2020Oct.5 [cited 2020Oct.28];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/946
Section
Original