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Recovery of health-related quality of life after laparoscopic versus open distal pancreatectomy

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Limited data comparing recovery of health-related quality of life (HRQoL) after laparoscopic (LDP) versus open distal pancreatectomy (ODP) are available. The aim of this study was to assess the impact of laparoscopy on postoperative HRQOL after DP using the Patient-Reported Outcomes Measurement Information System (PROMIS).

Methods

Data from consecutive patients who underwent DP (2020–2022) enrolled in a prospective clinical trial were reviewed. Patients completed PROMIS-29 plus 2 profile preoperatively, at postoperative day (POD) 15, 30, 90, and 180. Linear regression analysis adjusting for confounders including preoperative PROMIS scores, age, gender, ASA score, diagnosis, and multivisceral resection was used to estimate mean between-group differences (MD) in postoperative PROMIS domains T scores.

Results

Overall, 202 patients (118 laparoscopic, 86 open) underwent DP (median age 66 years, pancreatic cancer 41%, multivisceral resection 10%, median LOS 6 days). At POD15, LDP was associated with higher physical function (MD 5.6) and participation in social roles and activities scores (MD 3.8), reduced fatigue (MD − 2.7) and sleep disturbance (MD − 3.8) compared to ODP. At POD30, LDP patients had higher physical function (MD 5.2) and participation in social roles and activities scores (MD 6.0), reduced fatigue (MD − 3.5), and anxiety (MD − 4.0) compared to ODP. No between-group differences were found in HRQoL domains at POD90 and 180. Six months after surgery, the proportions of patients who had not recovered to preoperative physical function, participation in social roles and activities, fatigue, pain interference, sleep disturbance, cognitive function, depression, and anxiety were 31%, 31%, 28%, 20%, 15%, 14%, 8%, and 7%, respectively.

Conclusions

According to PROMIS, LDP resulted in improved physical and social functioning and reduced anxiety and fatigue up to 30 days after surgery compared to ODP. At 6 months after surgery, recovery of physical domains is still incomplete in up to 30% of patients.

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References

  1. De Rooij T, Van Hilst J, Van Santvoort H, Boerma D, Van Den Boezem P, Daams F, Van Dam R, Dejong C, Van Duyn E, Dijkgraaf M, Van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, De Hingh I, Kazemier G, Klaase J, De Kleine R, Van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269:2–9. https://doi.org/10.1097/SLA.0000000000002979

    Article  PubMed  Google Scholar 

  2. Björnsson B, Larsson AL, Hjalmarsson C, Gasslander T, Sandström P (2020) Comparison of the duration of hospital stay after laparoscopic or open distal pancreatectomy: randomized controlled trial. Br J Surg 107:1281–1288. https://doi.org/10.1002/BJS.11554

    Article  PubMed  Google Scholar 

  3. Korrel M, Vissers FL, van Hilst J, de Rooij T, Dijkgraaf MG, Festen S, Groot Koerkamp B, Busch OR, Luyer MD, Sandström P, Abu Hilal M, Besselink MG, Björnsson B (2021) Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials. Hepato-Pancreato-Biliary (Oxford) 23:323–330. https://doi.org/10.1016/J.HPB.2020.10.022

    Article  Google Scholar 

  4. van Hilst J, Strating EA, de Rooij T, Daams F, Festen S, Groot Koerkamp B, Klaase JM, Luyer M, Dijkgraaf MG, Besselink MG, van Santvoort HC, de Boer MT, Boerma D, van den Boezem PB, van Dam RM, Dejong CH, van Duyn EB, van Eijck CH, Gerhards MF, de Hingh IH, Kazemier G, de Kleine RH, van Laarhoven CJ, Patijn GA, Steenvoorde P, Suker M, Hilal MA (2019) Costs and quality of life in a randomized trial comparing minimally invasive and open distal pancreatectomy (LEOPARD trial). Br J Surg 106:910–921. https://doi.org/10.1002/BJS.11147

    Article  PubMed  Google Scholar 

  5. Johansen K, Lindhoff Larsson A, Lundgren L, Gasslander T, Hjalmarsson C, Sandström P, Björnsson B (2023) Quality of life after open versus laparoscopic distal pancreatectomy: long-term results from a randomized clinical trial. BJS open. https://doi.org/10.1093/BJSOPEN/ZRAD002

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rajabiyazdi F, Alam R, Pal A, Montanez J, Law S, Pecorelli N, Watanabe Y, Chiavegato LD, Falconi M, Hirano S, Mayo NE, Lee L, Feldman LS, Fiore JF (2021) Understanding the meaning of recovery to patients undergoing abdominal surgery. JAMA Surg 156:758–765. https://doi.org/10.1001/JAMASURG.2021.1557

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fiore JF, Figueiredo S, Balvardi S, Lee L, Nauche B, Landry T, Mayo NE, Feldman LS (2018) How do we value postoperative recovery? Ann Surg 267:656–669. https://doi.org/10.1097/SLA.0000000000002415

    Article  PubMed  Google Scholar 

  8. Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF, Shaw AD, Thacker JKM, Gan TJ, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M (2018) American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on patient-reported outcomes in an enhanced recovery pathway. Anesth Analg 126:1874–1882. https://doi.org/10.1213/ANE.0000000000002758

    Article  PubMed  Google Scholar 

  9. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, Ader D, Fries JF, Bruce B, Rose M (2007) The patient-reported outcomes measurement information system (PROMIS): progress of an NIH roadmap cooperative group during its first two years. Med Care. https://doi.org/10.1097/01.MLR.0000258615.42478.55

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pecorelli N, Guarneri G, Vallorani A, Limongi C, Licinio AW, Di Salvo F, Tamburrino D, Partelli S, Crippa S, Falconi M (2023) Validation of the PROMIS-29 questionnaire as a measure of recovery after pancreatic surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000006020

    Article  PubMed  Google Scholar 

  11. Kaat AJ, Rothrock NE, Vrahas MS, O’Toole RV, Buono SK, Zerhusen T, Gershon RC (2017) Longitudinal validation of the PROMIS physical function item bank in upper extremity trauma. J Orthop Trauma 31:e321–e326. https://doi.org/10.1097/BOT.0000000000000924

    Article  PubMed  Google Scholar 

  12. Balzano G, Guarneri G, Pecorelli N, Paiella S, Rancoita PMV, Bassi C, Falconi M (2020) Modelling centralization of pancreatic surgery in a nationwide analysis. Br J Surg 107:1510–1519. https://doi.org/10.1002/bjs.11716

    Article  CAS  PubMed  Google Scholar 

  13. Balzano G, Guarneri G, Pecorelli N, Reni M, Capurso G, Falconi M (2021) A four-step method to centralize pancreatic surgery, accounting for volume, performance and access to care. Hepato-Pancreato-Biliary (Oxford) 23:1095–1104. https://doi.org/10.1016/J.HPB.2020.11.006

    Article  Google Scholar 

  14. Pecorelli N, Mazza M, Guarneri G, Delpini R, Partelli S, Balzano G, Turi S, Meani R, Beretta L, Falconi M (2021) Impact of care pathway adherence on recovery following distal pancreatectomy within an enhanced recovery program. HPB (Oxford) 23:1815–1823. https://doi.org/10.1016/J.HPB.2021.04.016

    Article  PubMed  Google Scholar 

  15. Braga M, Ridolfi C, Balzano G, Castoldi R, Pecorelli N, Di Carlo V (2012) Learning curve for laparoscopic distal pancreatectomy in a high-volume hospital. Updates Surg 64:179–183. https://doi.org/10.1007/S13304-012-0163-2

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  18. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of cdc definitions of surgical wound infections. Infect Control Hosp Epidemiol. https://doi.org/10.1086/646436

    Article  PubMed  Google Scholar 

  19. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. https://doi.org/10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  20. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  21. Liu H, Cella D, Gershon R, Shen J, Morales LS, Riley W, Hays RD (2010) Representativeness of the patient-reported outcomes measurement information system internet panel. J Clin Epidemiol 63:1169–1178. https://doi.org/10.1016/j.jclinepi.2009.11.021

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mouelhi Y, Jouve E, Castelli C, Gentile S (2020) How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. https://doi.org/10.1186/S12955-020-01344-W

    Article  PubMed  PubMed Central  Google Scholar 

  23. Søreide K, Olsen F, Nymo LS, Kleive D, Lassen K (2019) A nationwide cohort study of resection rates and short-term outcomes in open and laparoscopic distal pancreatectomy. HPB (Oxford) 21:669–678. https://doi.org/10.1016/J.HPB.2018.10.006

    Article  PubMed  Google Scholar 

  24. Maggino L, Malleo G, Salvia R, Bassi C, Vollmer CM (2019) Defining the practice of distal pancreatectomy around the world. HPB (Oxford) 21:1277–1287. https://doi.org/10.1016/J.HPB.2019.02.016

    Article  PubMed  Google Scholar 

  25. Lee L, Dumitra T, Fiore JF, Mayo NE, Feldman LS (2015) How well are we measuring postoperative “recovery” after abdominal surgery? Qual Life Res 24:2583–2590. https://doi.org/10.1007/S11136-015-1008-5

    Article  PubMed  Google Scholar 

  26. Braga M, Pecorelli N, Ferrari D, Balzano G, Zuliani W, Castoldi R (2015) Results of 100 consecutive laparoscopic distal pancreatectomies: postoperative outcome, cost-benefit analysis, and quality of life assessment. Surg Endosc 29:1871–1878. https://doi.org/10.1007/S00464-014-3879-X

    Article  PubMed  Google Scholar 

  27. Korrel M, Roelofs A, van Hilst J, Busch OR, Daams F, Festen S, Groot Koerkamp B, Klaase J, Luyer MD, van Oijen MG, Verdonck-de Leeuw IM, Besselink MG, van Santvoort HC, de Boer MT, Boerma D, van den Boezem PB, van Dam RM, Dejong CH, van Duyn EB, van Eijck CH, Gerhards MF, de Hingh IH, Kazemier G, de Kleine RH, van Laarhoven CJ, Patijn GA, Steenvoorde P, Suker M, Hilal MA (2021) Long-term quality of life after minimally invasive vs open distal pancreatectomy in the LEOPARD randomized trial. J Am Coll Surg 233:730–739.e9. https://doi.org/10.1016/J.JAMCOLLSURG.2021.08.687

    Article  PubMed  Google Scholar 

  28. McCombie AM, Frizelle F, Bagshaw PF, Frampton CM, Hewett PJ, McMurrick PJ, Rieger N, Solomon MJ, Stevenson AR (2018) The ALCCaS trial: a randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for colon cancer. Dis Colon Rectum 61:1156–1162. https://doi.org/10.1097/DCR.0000000000001165

    Article  PubMed  Google Scholar 

  29. Korrel M, Jones LR, van Hilst J, Balzano G, Björnsson B, Boggi U, Bratlie SO, Busch OR, Butturini G, Capretti G, Casadei R, Edwin B, Emmen AMLH, Esposito A, Falconi M, Groot Koerkamp B, Keck T, de Kleine RHJ, Kleive DB, Kokkola A, Lips DJ, Lof S, Luyer MDP, Manzoni A, Marudanayagam R, de Pastena M, Pecorelli N, Primrose JN, Ricci C, Salvia R, Sandström P, Vissers FLIM, Wellner UF, Zerbi A, Dijkgraaf MGW, Besselink MG, Abu Hilal M, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) (2023) Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial. Lancet Reg Health Eur 31:100673. https://doi.org/10.1016/j.lanepe.2023.100673

    Article  PubMed  PubMed Central  Google Scholar 

  30. Heerkens HD, Tseng DSJ, Lips IM, Van Santvoort HC, Vriens MR, Hagendoorn J, Meijer GJ, Borel Rinkes IHM, Van Vulpen M, Molenaar IQ (2016) Health-related quality of life after pancreatic resection for malignancy. Br J Surg 103:257–266. https://doi.org/10.1002/BJS.10032

    Article  CAS  PubMed  Google Scholar 

  31. Naffouje SA, Kamarajah SK, Denbo JW, Salti GI, Dahdaleh FS (2022) Surgical approach does not affect return to intended oncologic therapy following pancreaticoduodenectomy for pancreatic adenocarcinoma: a propensity-matched study. Ann Surg Oncol 29:7793–7803. https://doi.org/10.1245/s10434-022-12347-w

    Article  PubMed  Google Scholar 

  32. Alam R, Montanez J, Law S, Lee L, Pecorelli N, Watanabe Y, Chiavegato LD, Falconi M, Hirano S, Mayo NE, Feldman LS, Fiore JF Jr (2020) Development of a conceptual framework of recovery after abdominal surgery. Surg Endosc 34:2665–2674. https://doi.org/10.1007/s00464-019-07044-x

    Article  PubMed  Google Scholar 

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Acknowledgements

Giovanni Guarneri research fellowship is funded by the Umberto Veronesi Foundation.

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Authors and Affiliations

  1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Nicolò Pecorelli, Giovanni Guarneri, Francesca Di Salvo, Stefano Crippa, Stefano Partelli, Gianpaolo Balzano & Massimo Falconi

  2. Vita-Salute San Raffaele University, Milan, Italy

    Nicolò Pecorelli, Alessia Vallorani, Chiara Limongi, Alice W. Licinio, Stefano Crippa, Stefano Partelli & Massimo Falconi

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  1. Nicolò Pecorelli
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Correspondence to Nicolò Pecorelli.

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Nicolò Pecorelli, Giovanni Guarneri, Alessia Vallorani, Chiara Limongi, Alice Licinio Wong, Francesca Di Salvo, Stefano Crippa, Stefano Partelli, Gianpaolo Balzano, and Massimo Falconi have no conflicts of interests or financial ties to disclose.

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Pecorelli, N., Guarneri, G., Vallorani, A. et al. Recovery of health-related quality of life after laparoscopic versus open distal pancreatectomy. Surg Endosc 38, 327–338 (2024). https://doi.org/10.1007/s00464-023-10453-8

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