- Design
- Nationwide prospective longitudinal cohort
- Population
- 1,009 patients having pancreatectomy for pancreatic cancer, 2,995 questionnaires
- Primary outcome
- Gastrointestinal symptom scores and health-related quality of life over 12 months
- Effect
- Symptoms in 95% before surgery; severe symptoms 61% before and 52% at 9 to 12 months
In a Dutch nationwide cohort of 1,009 patients who completed 2,995 questionnaires, gastrointestinal symptoms were present in 95% before pancreatectomy for pancreatic cancer. Common ones were flatulence, dry mouth, altered taste and altered bowel habits.
Symptom scores peaked in the first three months after surgery and generally returned to preoperative levels or lower by nine to twelve months. Severe symptoms affected 61% of patients before surgery and 52% at nine to twelve months. Patients with two or more severe symptoms had moderate to large clinically relevant reductions in quality of life, of 10 to more than 20 points.
Symptoms are already present before the operation, so postoperative complaints cannot all be put down to the procedure. Asking at baseline gives a reference point.
- 95% reported gastrointestinal symptoms before surgery.
- Symptom scores peaked within three months after pancreatectomy.
- Severe symptoms still affected 52% at nine to twelve months.
- Two or more severe symptoms went with a clinically relevant fall in quality of life.
- Record a symptom baseline before surgery so changes can be interpreted.
Why it matters
Symptoms attributed to the operation are often there beforehand, which changes how follow-up should be framed.
Don't overread it
Questionnaire responders may differ from non-responders, and the study cannot say which symptoms are caused by surgery.
The statistics, in plain English
A 10 to 20 point difference on these quality-of-life scales is conventionally regarded as a moderate change that patients notice, and above 20 as large. Because this is a cohort, the link between symptoms and quality of life is an association and may run in either direction.
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