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Long-term quality of life is better after laparoscopic compared to open pancreatoduodenectomy

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Abstract

Background

Three randomized controlled trials have reported improved functional recovery after Laparoscopic pancreatoduodenectomy (LPD), as compared to open pancreatoduodenectomy (OPD). Long-term results regarding quality of life (QoL) are lacking. The aim of this study was to compare long-term QoL of LPD versus OPD.

Methods and patients

A monocentric retrospective cross-sectional study was performed among patients < 75 years old who underwent LPD or OPD for a benign or premalignant pathology in a high-volume center (2011–2021). An electronic three-part questionnaire was sent to eligible patients, including two diseases specific QoL questionnaires (the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire for cancer (QLQ-C30) and a pancreatic cancer module (PAN26) and a body image questionnaire. Patient demographics and postoperative data were collected and compared between LPD and OPD.

Results

Among 948 patients who underwent PD (137 LPD, 811 OPD), 170 were eligible and 111 responded (58 LPD and 53 OPD). LPD versus OPD showed no difference in mean age (51 vs. 55 years, p = 0.199) and female gender (40% vs. 45%, p = 0.631), but LPD showed lower BMI (24 vs 26; p = 0.028) and higher preoperative pancreatitis (29% vs 13%; p = 0.041). The postoperative outcome showed similar Clavien–Dindo ≥ III morbidity (19% vs. 23%; p = 0.343) and length of stay (24 vs. 21 days, p = 0.963). After a similar median follow-up (3 vs. 3 years; p = 0.122), LPD vs OPD patients reported higher QoL (QLQ-C30: 49.6 vs 56.3; p = 0.07), better pancreas specific health status score (PAN20: 50.5 vs 55.5; p = 0.002), physical functioning (p = 0.002), and activities limitations (p = 0.02). Scar scores were better after LPD regarding esthetics (p = 0.001), satisfaction (p = 0.04), chronic pain at rest (p = 0.036), moving (p = 0.011) or in daily activities (p = 0.02). There was no difference in digestive symptoms (p = 0.995).

Conclusion

This monocentric study found improved long-term QoL in patients undergoing LPD, as compared to OPD, for benign and premalignant diseases. These results could be considered when choosing the surgical approach in these patients.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, APHP, Hôpital Beaujon, DMU DIGEST, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Claire Dagorno, Lancelot Marique, Camille Thouny, Fadhel Samir Ftériche, Béatrice Aussilhou, Mickael Lesurtel, Alain Sauvanet & Safi Dokmak

  2. Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands

    Maarten Korrel & Nine de Graaf

  3. Cancer Center Amsterdam, Amsterdam, The Netherlands

    Maarten Korrel & Nine de Graaf

  4. Plateforme d’Imagerie du Vivant (PIV), Hôpital Cochin, Paris, France

    Gilles Renault

  5. Department of Pancreatology, APHP, Hôpital Beaujon, DMU DIGEST, Clichy, France

    Frédérique Maire, Philippe Lévy & Vinciane Rebours

  6. Université de Paris Cité, Paris, France

    Philippe Lévy, Vinciane Rebours, Mickael Lesurtel, Alain Sauvanet & Safi Dokmak

Authors
  1. Claire Dagorno
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  2. Lancelot Marique
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  7. Fadhel Samir Ftériche
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  8. Béatrice Aussilhou
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  9. Frédérique Maire
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  10. Philippe Lévy
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  11. Vinciane Rebours
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  12. Mickael Lesurtel
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  13. Alain Sauvanet
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  14. Safi Dokmak
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Corresponding author

Correspondence to Safi Dokmak.

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Disclosures

Claire Dagorno, Lancelot Marique, Maarten Korrel, Nine de Graaf, Camille Thouny, Gilles Renault, Fadhel Samir Ftériche, Béatrice Aussilhou, Frédérique Maire, Philippe Lévy, Vinciane Rebours, Mickael Lesurtel, Alain Sauvanet, and Safi Dokmak have no conflicts of interest or financial ties to disclose.

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Dagorno, C., Marique, L., Korrel, M. et al. Long-term quality of life is better after laparoscopic compared to open pancreatoduodenectomy. Surg Endosc 38, 769–779 (2024). https://doi.org/10.1007/s00464-023-10581-1

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