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Assessment of the Long-Term Impact of Pancreatoduodenectomy on Health-Related Quality of Life Using the EORTC QLQ-PAN26 Module

  • Hepatobiliary Tumors
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Long-term pancreatoduodenectomy (PD) survivors have previously reported favorable quality of life (QoL). However, there has been a paucity of studies utilizing pancreas-specific modules for QoL assessment, which may uncover disability that general modules cannot detect.


The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-PAN26 questionnaires were administered to PD survivors who were at least 5 years out of their operations for neoplasms (1998–2011, study cohort) and compared their scores with published preoperative scores of patients with pancreatic cancer (control cohort). The clinical relevance (CR) of differences was scored as small (5–10), moderate (10–20), or large (> 20) based on validated interpretation of clinically important differences.


Of 1266 patients who underwent PD, there were 305 survivors with valid contact information, of whom 248 responded to the questionnaire (response rate 81.3%) and made up the study cohort. The median follow-up was 9.1 years (range 5.1–21.2 years). When compared with the control cohort, patients in the study cohort reported higher pancreatic pain (41.7 ± 17.6 vs. 18.1 ± 20.5, < 0.001, CR large), sexuality dissatisfaction (63.0 ± 37.5 vs. 35.1 ± 34.3, < 0.001, CR large), altered bowel habits (37.6 ± 30.6 vs. 20.0 ± 24.5, < 0.001, CR moderate), and digestive symptoms (26.3 ± 29.5 vs. 18.7 ± 27.8, = 0.002, CR small) scores. There was a higher prevalence of bloating, indigestion, and flatulence, but lower prevalence of future health worry (71.7% vs. 89.6%, < 0.001) and limitation in planning activities (30.1% vs. 48.3%, < 0.001) at 5 years.


While post-PD patients had better long-term global QoL than healthy controls, a more granular, pancreas-specific questionnaire uncovered digestive abnormalities and sexuality dissatisfaction. These data can better inform clinical decision making and provide potential areas for improvement and patient support.

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  1. Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S4–12.

    Article  Google Scholar 

  2. Farrell JJ, Fernandez-del CC. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology. 2013;144(6):1303–15.

    Article  Google Scholar 

  3. Ferrone CR, Marchegiani G, Hong TS, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261(1):12–7.

    Article  Google Scholar 

  4. Michelakos T, Pergolini I, Castillo CF, et al. Predictors of resectability and survival in patients with borderline and locally advanced pancreatic cancer who underwent neoadjuvant treatment With FOLFIRINOX. Ann Surg. 2019;269(4):733–40.

    Article  Google Scholar 

  5. Von Hoff DD, Ramanathan RK, Borad MJ, et al. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol. 2011;29(34):4548–54.

    Article  Google Scholar 

  6. Macedo FI, Ryon E, Maithel SK, et al. Survival outcomes associated with clinical and pathological response following neoadjuvant FOLFIRINOX or gemcitabine/nab-paclitaxel chemotherapy in resected pancreatic cancer. Ann Surg. 2019;270(3):400–13.

    Article  Google Scholar 

  7. Schniewind B, Bestmann B, Henne-Bruns D, et al. Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head. Br J Surg. 2006;93(9):1099–107.

    Article  CAS  Google Scholar 

  8. Huang JJ, Yeo CJ, Sohn TA, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg. 2000;231(6):890–8.

    Article  CAS  Google Scholar 

  9. Fong ZV, Alvino DM, Castillo CF, et al. Health-related quality of life and functional outcomes in 5-year survivors after pancreaticoduodenectomy. Ann Surg. 2017;266(4):685–92.

    Article  Google Scholar 

  10. Allen CJ, Yakoub D, Macedo FI, et al. Long-term quality of life and gastrointestinal functional outcomes after pancreaticoduodenectomy. Ann Surg. 2018;268(4):657–64.

    Article  Google Scholar 

  11. Fitzsimmons D, Johnson CD, George S, et al. Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC Study Group on Quality of Life. Eur J Cancer. 1999;35(6):939–41.

    Article  CAS  Google Scholar 

  12. Eaton AAKP, Johnson CD, et al. Psychometric validation of the EORTC QLQ-PAN26 pancreatic cancer module for assessing health related quality of life after pancreatic resection. Pancreas. 2017;18(1):19–25.

    Google Scholar 

  13. Eaton AA, Gonen M, Karanicolas P, et al. Health-related quality of life after pancreatectomy: results from a randomized controlled trial. Ann Surg Oncol. 2016;23(7):2137–45.

    Article  Google Scholar 

  14. Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44.

    Article  CAS  Google Scholar 

  15. Balcom JH, Rattner DW, Warshaw AL, et al. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136(4):391–8.

    Article  Google Scholar 

  16. Winter JM, Cameron JL, Lillemoe KD, et al. (2006) Periampullary and pancreatic incidentaloma: a single institution's experience with an increasingly common diagnosis. Ann Surg 243(5):673–80; discussion 680-3.

  17. van Rijssen LB, Gerritsen A, Henselmans I, et al. Core set of patient-reported outcomes in pancreatic cancer (COPRAC): an international delphi study among patients and health care providers. Ann Surg. 2019;270(1):158–64.

    Article  Google Scholar 

  18. Heerkens HD, van Berkel L, Tseng DSJ, et al. Long-term health-related quality of life after pancreatic resection for malignancy in patients with and without severe postoperative complications. HPB (Oxford). 2018;20(2):188–95.

    Article  Google Scholar 

  19. Short M, Goldstein D, Halkett G, et al. Impact of gemcitabine chemotherapy and 3-dimensional conformal radiation therapy/5-fluorouracil on quality of life of patients managed for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(1):157–62.

    Article  CAS  Google Scholar 

  20. Serrano PE, Herman JM, Griffith KA, et al. Quality of life in a prospective, multicenter phase 2 trial of neoadjuvant full-dose gemcitabine, oxaliplatin, and radiation in patients with resectable or borderline resectable pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2014;90(2):270–7.

    Article  CAS  Google Scholar 

  21. Arvaniti M, Danias N, Theodosopoulou E, et al. Quality of life variables assessment, before and after pancreatoduodenectomy (PD): prospective study. Glob J Health Sci. 2015;8(6):203–10.

    Article  Google Scholar 

  22. Arvaniti M, Danias N, Igoumenidis M, et al. Comparison of quality of life before and after pancreaticoduodenectomy: a prospective study. Electron Physician. 2018;10(7):7054–62.

    Article  Google Scholar 

  23. Cloyd JM, Tran Cao HS, Petzel MQ, et al. Impact of pancreatectomy on long-term patient-reported symptoms and quality of life in recurrence-free survivors of pancreatic and periampullary neoplasms. J Surg Oncol. 2017;115(2):144–50.

    Article  Google Scholar 

  24. Rashid L, Velanovich V. Symptomatic change and gastrointestinal quality of life after pancreatectomy. HPB (Oxford). 2012;14(1):9–13.

    Article  Google Scholar 

  25. Lim PW, Dinh KH, Sullivan M, et al. Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection. HPB (Oxford). 2016;18(4):360–6.

    Article  Google Scholar 

  26. Gan C, Chen YH, Liu L, et al. Efficacy and safety of pancreatic enzyme replacement therapy on exocrine pancreatic insufficiency: a meta-analysis. Oncotarget. 2017;8(55):94920–31.

    Article  Google Scholar 

  27. Landers A, Brown H, Strother M. The effectiveness of pancreatic enzyme replacement therapy for malabsorption in advanced pancreatic cancer, a pilot study. Palliat Care. 2019;12:1178224218825270.

    PubMed  PubMed Central  Google Scholar 

  28. Puri PM, Watkins AA, Kent TS, et al. Decision-making for the management of cystic lesions of the pancreas: how satisfied are patients with surgery? J Gastrointest Surg. 2018;22(1):88–97.

    Article  Google Scholar 

  29. Eaton AA, Karanicolas P, Johnson CD, et al. Psychometric validation of the EORTC QLQ-PAN26 pancreatic cancer module for assessing health related quality of life after pancreatic resection. J Pancreas. 2017;18(1):19–25.

    Google Scholar 

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The authors would like to thank the Andrew L. Warshaw, MD Institute for Pancreatic Cancer Research for their funding support for this study.


Funding was provided by Institute for Pancreatic Cancer Research (Grant No. 0004852948).

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Correspondence to Cristina R. Ferrone MD.

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Fong, Z.V., Sekigami, Y., Qadan, M. et al. Assessment of the Long-Term Impact of Pancreatoduodenectomy on Health-Related Quality of Life Using the EORTC QLQ-PAN26 Module. Ann Surg Oncol 28, 4216–4224 (2021).

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