Pancreatic surgery - The recovery perspective

Abstract

Background: Pancreaticoduodenectomy (PD) is among the most demanding surgical procedures a patient can undergo. The introduction of enhanced recovery programs (ERPs) has improved short-term clinical outcomes, including length of stay (LoS) and complication rates. However, little is known about patients’ perceptions and reports of postoperative recovery over time, and the link between health status and recovery remains unclear. Hence, the overall aim was to elucidate postoperative recovery after PD. Methods: This thesis is based on four papers, including three separate cohorts. In paper I patients’ perceptions on their experiences from recovering from pancreaticoduodenectomy is explored using a qualitative approach. Papers II-IV employed a prospective cohort design. Additionally, in paper II a retrospective, pre-ERP cohort, was compared with a prospective ERP cohort in terms of health status (HS) and health related quality of life (HRQoL) cohort using EQ-5D-3L, EORTC QLQ-C30, and PAN26, with three- and six-months follow-up. In paper III, the association between systemic inflammatory response, expressed by c-reactive protein (CRP), and recovery assessed with SwQoR-24. Paper IV assessed the relationship between preoperative health status and long-term patient-reported recovery. Results: Patients sought to resume their former lives and sense of self as they were before surgery. Additionally, while physical experiences were found to hinder recovery, social and emotional experiences facilitated it. The introduction of ERP significantly reduced LoS. However, it did not translate to a measurable difference in HRQoL at three and six-month follow-up. Systemic inflammation measured by CRP was not associated with patient reported postoperative recovery. Instead, and preoperative HS emerged as a predictor of late postoperative recovery. Conclusion: Recovery after PD is a prolonged process, primarily influenced by patient-related factors rather than by perioperative SIR or ERP. While ERP reduces length of stay, it mainly benefits the intermediate phase of recovery and does not significantly affect HRQoL. Patient reported outcomes, particularly recovery measures, provide insights to the patient perspective more accurately.