Pancreatoduodenal surgery in patients with multiple endocrine neoplasia type 1: Operative outcomes, long-term function, and quality of life

Y. Nancy You, Geoffrey B. Thompson, William Francis Young, Dirk Larson, David R. Farley, Melanie Richards, Clive S. Grant

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Abstract

Background: Pancreatoduodenal (PD) neoplasms represent the principal disease-specific lethality in multiple endocrine neoplasia type 1 (MEN1). Potential oncologic benefits of PD resection must be weighed against operative morbidities, compromised pancreatic function, and quality of life (QOL). Methods: Fifty MEN1 patients underwent PD resections during 1984-2004. Postoperative pancreatic function and QOL were assessed by EORTC QLQ-C30 and a disease-specific questionnaire (response rate, 78%). Results: Twelve patients (24%) had asymptomatic disease detected by screening; 38 patients (76%) were symptomatic. All gross neoplasm was resected in 80% of patients. No patients died; 21 patients (42%) had complications. At 5 years postoperatively, 60% of patients were alive without disease, 24% of patients were with disease, 10% of patients died of PD neoplasms, 4% of patients died of other malignancies, and 2% of patients died of an unknown cause. Diabetes that requires insulin or oral hypoglycemics developed in 20% of patients. Frequent steatorrhea (>once/week) occurred in 25% of patients, early dumping occurred in 25% of patients, bloating occurred in 25% of patients, late dumping occurred in 7% of patients, hypoglycemia occurred in 7% of patients, and vomiting occurred in 4% of patients. Global QOL did not differ from that of the reference population (72.8 vs 75.3; P = .58). Conclusion: PD resections in MEN1 are associated with perioperative risks and altered pancreatic function. The moderate compromise in patient-perceived QOL suggests that most patients accept and adapt to these trade-offs for the potential of prolonged survival.

Original languageEnglish (US)
Pages (from-to)829-836
Number of pages8
JournalSurgery
Volume142
Issue number6
DOIs
StatePublished - Dec 2007

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Multiple Endocrine Neoplasia Type 1
Quality of Life
Patient Transfer
Neoplasms
Steatorrhea
Asymptomatic Diseases

ASJC Scopus subject areas

  • Surgery

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Pancreatoduodenal surgery in patients with multiple endocrine neoplasia type 1 : Operative outcomes, long-term function, and quality of life. / You, Y. Nancy; Thompson, Geoffrey B.; Young, William Francis; Larson, Dirk; Farley, David R.; Richards, Melanie; Grant, Clive S.

In: Surgery, Vol. 142, No. 6, 12.2007, p. 829-836.

Research output: Contribution to journalArticle

You, Y. Nancy ; Thompson, Geoffrey B. ; Young, William Francis ; Larson, Dirk ; Farley, David R. ; Richards, Melanie ; Grant, Clive S. / Pancreatoduodenal surgery in patients with multiple endocrine neoplasia type 1 : Operative outcomes, long-term function, and quality of life. In: Surgery. 2007 ; Vol. 142, No. 6. pp. 829-836.
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abstract = "Background: Pancreatoduodenal (PD) neoplasms represent the principal disease-specific lethality in multiple endocrine neoplasia type 1 (MEN1). Potential oncologic benefits of PD resection must be weighed against operative morbidities, compromised pancreatic function, and quality of life (QOL). Methods: Fifty MEN1 patients underwent PD resections during 1984-2004. Postoperative pancreatic function and QOL were assessed by EORTC QLQ-C30 and a disease-specific questionnaire (response rate, 78{\%}). Results: Twelve patients (24{\%}) had asymptomatic disease detected by screening; 38 patients (76{\%}) were symptomatic. All gross neoplasm was resected in 80{\%} of patients. No patients died; 21 patients (42{\%}) had complications. At 5 years postoperatively, 60{\%} of patients were alive without disease, 24{\%} of patients were with disease, 10{\%} of patients died of PD neoplasms, 4{\%} of patients died of other malignancies, and 2{\%} of patients died of an unknown cause. Diabetes that requires insulin or oral hypoglycemics developed in 20{\%} of patients. Frequent steatorrhea (>once/week) occurred in 25{\%} of patients, early dumping occurred in 25{\%} of patients, bloating occurred in 25{\%} of patients, late dumping occurred in 7{\%} of patients, hypoglycemia occurred in 7{\%} of patients, and vomiting occurred in 4{\%} of patients. Global QOL did not differ from that of the reference population (72.8 vs 75.3; P = .58). Conclusion: PD resections in MEN1 are associated with perioperative risks and altered pancreatic function. The moderate compromise in patient-perceived QOL suggests that most patients accept and adapt to these trade-offs for the potential of prolonged survival.",
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AU - Richards, Melanie

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N2 - Background: Pancreatoduodenal (PD) neoplasms represent the principal disease-specific lethality in multiple endocrine neoplasia type 1 (MEN1). Potential oncologic benefits of PD resection must be weighed against operative morbidities, compromised pancreatic function, and quality of life (QOL). Methods: Fifty MEN1 patients underwent PD resections during 1984-2004. Postoperative pancreatic function and QOL were assessed by EORTC QLQ-C30 and a disease-specific questionnaire (response rate, 78%). Results: Twelve patients (24%) had asymptomatic disease detected by screening; 38 patients (76%) were symptomatic. All gross neoplasm was resected in 80% of patients. No patients died; 21 patients (42%) had complications. At 5 years postoperatively, 60% of patients were alive without disease, 24% of patients were with disease, 10% of patients died of PD neoplasms, 4% of patients died of other malignancies, and 2% of patients died of an unknown cause. Diabetes that requires insulin or oral hypoglycemics developed in 20% of patients. Frequent steatorrhea (>once/week) occurred in 25% of patients, early dumping occurred in 25% of patients, bloating occurred in 25% of patients, late dumping occurred in 7% of patients, hypoglycemia occurred in 7% of patients, and vomiting occurred in 4% of patients. Global QOL did not differ from that of the reference population (72.8 vs 75.3; P = .58). Conclusion: PD resections in MEN1 are associated with perioperative risks and altered pancreatic function. The moderate compromise in patient-perceived QOL suggests that most patients accept and adapt to these trade-offs for the potential of prolonged survival.

AB - Background: Pancreatoduodenal (PD) neoplasms represent the principal disease-specific lethality in multiple endocrine neoplasia type 1 (MEN1). Potential oncologic benefits of PD resection must be weighed against operative morbidities, compromised pancreatic function, and quality of life (QOL). Methods: Fifty MEN1 patients underwent PD resections during 1984-2004. Postoperative pancreatic function and QOL were assessed by EORTC QLQ-C30 and a disease-specific questionnaire (response rate, 78%). Results: Twelve patients (24%) had asymptomatic disease detected by screening; 38 patients (76%) were symptomatic. All gross neoplasm was resected in 80% of patients. No patients died; 21 patients (42%) had complications. At 5 years postoperatively, 60% of patients were alive without disease, 24% of patients were with disease, 10% of patients died of PD neoplasms, 4% of patients died of other malignancies, and 2% of patients died of an unknown cause. Diabetes that requires insulin or oral hypoglycemics developed in 20% of patients. Frequent steatorrhea (>once/week) occurred in 25% of patients, early dumping occurred in 25% of patients, bloating occurred in 25% of patients, late dumping occurred in 7% of patients, hypoglycemia occurred in 7% of patients, and vomiting occurred in 4% of patients. Global QOL did not differ from that of the reference population (72.8 vs 75.3; P = .58). Conclusion: PD resections in MEN1 are associated with perioperative risks and altered pancreatic function. The moderate compromise in patient-perceived QOL suggests that most patients accept and adapt to these trade-offs for the potential of prolonged survival.

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