Long-term functional outcomes and quality of life assessment after pancreatic resection for low grade IPMN

Introduction: Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are precursor lesions that range from low- to high-grade dysplasia with the potential of progressing to invasive carcinoma. Accurate preoperative risk stratification remains challenging, leading to some patients undergoing surgery for lesions initially considered worrisome and later proven to be benign by final pathology results. Impact on long-term functional outcomes and quality of life (QoL) remain under investigated and could influence indications.

Aim: The aim of this study was to assess the long-term (>10years) impact on functional outcomes and QoL in patients resected for low-grade IPMN.

Methods: In this retrospective single center cohort-study, all patients undergoing pancreatic resection for low-grade IPMN at Heidelberg University Hospital from 10/2001-01/2012 were considered. During follow up, functional outcomes (e.g. weight loss, endo-/exocrine pancreatic function) were recorded. Health related QoL was assessed using the EORTC QLQ-C-30 questionnaire at least 10 years after surgery.

Results: Within the study period 583 patients underwent pancreatic resections for IPMN at Heidelberg University Hospital. Low grade dysplasia was found in 260 patients (44.6%) postoperatively. Long term follow-up (Median=13.17 years, IQR [11.67; 15.17]) and QoL assessment was available in 117 patients (45%). Pancreatoduodenectomy (PD) was performed in 45%, distal pancreatectomy (DP) in 23%, total pancreatectomy (TP) in 14% and parenchyma sparing procedures in 18% of cases. Long-term follow up revealed insulin-dependent diabetes among 29% of the study cohort (15% excluding TP), with 6% being known diabetics preoperatively. Occurrence was significantly higher after DP compared to PD (DP 35% vs. PD 13%, p=0.03) and parenchyma sparing approaches (5%, p=0.02). Scores for overall QoL were high (Mean=71.15, SD=22.89) and comparable to the normative German population (Mean=67.0, SD=21.8). Persisting diarrhea or occasional loose stool were reported in 6% and 23% of patients respectively. Overall physical functioning was not impaired compared to the general German population. (Mean 84.3=SD 23.0 vs. 82.8=21.2).

Conclusion: Long-term follow up after resection of premalignant IPMN showed sufficient preservation of pancreatic function resulting in excellent overall QoL. These results may help identifying patients benefitting from closer follow up, improving functional outcomes after resection for IPMN.

 

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Publication History

Article published online:
04 September 2025