Preoperative Quality of Life as Predictor of Postoperative Early Recurrence and Overall Survival in Patients with Pancreatic and Periampullary Adenocarcinoma

BACKGROUND: The purpose of the study was to investigate if preoperative assessment of quality of life (QoL) in patients with pancreatic and periampullary cancer can identify patients with reduced recurrence free and overall survival after pancreatic surgery. METHODS: A prospective study of patients planned for pancreatic surgery due to pancreatic and periampullary tumors. Participants completed the European Organization for Research and Treatment of Cancer (EORTC) C30 and PAN26 questionnaires preoperatively. RESULTS: Of 112 participants, 95 patients had pancreatic or periampullary adenocarcinoma, and 17 patients had benign pathology. The operations included pancreaticoduodenectomy (79), left pancreatectomy (1), total pancreatectomy (16), and exploratory laparotomy (16) due to locally advanced and/or metastatic disease. Patients with adenocarcinomas had a lower EORTC score in functional and social domains than patients with benign disease and a higher score within physical symptoms in both questionnaires. This was most pronounced in patients with advanced diseases. Patients with advanced disease or metastases and patients with recurrence within 6 months had significant deviations in several domains compared to patients without recurrence. However, there was only a weak relation between preoperative QoL scores and disease specific survival (DSS) and recurrence free survival (RFS) and only night pain remained in the model after multivariate regression (p = 0.013). Adjusted analyses for co-variates only showed association between outcome and lymph node stage. The overall survival, DSS and RFS was 30.9, 40.5, and 15.0 months, respectively. The recurrence rate in patients with PDAC and periampullary adenocarcinoma was 67% during the observation time, with a median time to recurrence of 9.0 (range 3.0-67.0) months. CONCLUSION: Among patients undergoing surgery for pancreatic and periampullary tumors, preoperative quality of life according to EORTC scores differed between patients with malignant and benign disease but was only weakly associated with survival outcomes.