Long-term quality of life after surgery for intraductal papillary mucinous neoplasms in young patients

BACKGROUND: Intraductal papillary mucinous neoplasms are increasingly detected in younger patients, but data on long-term outcomes after pancreatic resection in this age group remain limited. The potential burden of postoperative morbidity and its impact on health-related quality of life have raised concerns and often temper confidence in early surgical intervention. This study investigated long-term quality of life and functional outcomes in patients ages 50 years or younger who underwent resection for intraductal papillary mucinous neoplasms. METHODS: Perioperative and long-term follow-up data of patients who had undergone surgery for intraductal papillary mucinous neoplasms between 2004 and 2020 were analyzed. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer quality-of life-questionnaires QLQ-C30 and QLQ-PAN26. RESULTS: A total of 78 patients ages 50 years or younger underwent resection for intraductal papillary mucinous neoplasms. Median follow-up was 95 months, with long-term follow-up available in 56 patients (72%). Among the patients with available follow-up, the median age at the time of surgery was 46 years. The initial surgical procedures included pancreaticoduodenectomy in 30 patients (54%), distal pancreatectomy in 8 patients (14%), total pancreatectomy in 4 patients (7%), enucleation in 13 patients (23%), and middle segment resection in 1 patient (2%). Final histology confirmed intraductal papillary mucinous neoplasm-associated carcinoma in 4 patients (7%), high-grade intraductal papillary mucinous neoplasm in 14 patients (25%), and low-grade intraductal papillary mucinous neoplasm in 38 patients (68%). At the time of assessment, 35 patients (63%) required pancreatic enzyme substitution, and 9 patients (16%) had insulin-dependent diabetes mellitus, 5 of whom after total pancreatectomy. Patients reported excellent long-term quality of life. QLQ-C30 demonstrated a global health status of 71.1%, with high functioning scores (82.9%) and low symptom burden (16.8%). QLQ-PAN26 revealed an overall symptom score of 20.7%, with fatigue, insomnia, and diarrhea as the most common symptoms. For reference, quality-of-life scores closely matched those of the age-matched general German population, and parenchyma-sparing resections were associated with particularly favorable outcomes. CONCLUSION: Young patients undergoing pancreatic resection for intraductal papillary mucinous neoplasms achieve remarkably high long-term quality of life, comparable to the general population, despite potential exocrine or endocrine insufficiency. These findings support surgical management in young patients with IPMNs when clinically indicated and underscore a long life expectancy with a high level of well-being.