Discussion
ductal adenocarcinomas, cancer and pancreatic cancer
DUCTAL ADENOCARCINOMA
In this long-term follow-up of quality of life after distal pancreatectomy from a RCT, considerable differences were shown between patients who underwent open and laparoscopic distal pancreatectomy, with a preference for the minimally invasive method. Moreover, many of the domains showed a statistically significant and/or clinically relevant difference as late as 2 years after surgery. With the lack of previous research in this area, this study adds valuable information to strengthen the ongoing worldwide transition from open to minimally invasive distal pancreatectomy. Interestingly, when compared with sex- and age-matched Swedish reference values, the laparoscopic treatment arm approximated the general population values in many of the domains after 12–24 months.There was a difference between the two groups regarding the proportion of ductal adenocarcinoma. This was countered with a sensitivity analysis excluding patients with this diagnosis, which did not have a major impact on the results. One reason for this could be that the number of ductal adenocarcinomas was relatively small, affecting only seven of 54 patients. Interestingly, a higher proportion of ductal adenocarcinomas was seen in the group with better quality of life.The number of significant domains dropped to only two when comparing only patients who had undergone splenectomy between treatment arms. However, when doing separate analyses comparing all patients who had undergone a spleen-preserving procedure with those who had not, not many differences were shown. Therefore, the difference in the sensitivity analysis is interpreted as resulting from a lack of power when excluding 15 patients from a sample of only 54. Although there is a lack of studies on the effect of splenectomy together with distal pancreatectomy on quality of life, one small study published in 2016 comparing conventional laparoscopic distal pancreatectomy with the spleen-preserving alternative found no significant differences in overall quality of life for any of the measuring pointsWhen compared with the only available RCT on this subject, the LEOPARDAs minimally invasive surgery moves towards robot-assisted methods, there is a need to evaluate how this transition affects patients’ health-related quality of life. In a recent study using propensity score matching to evaluate differences between robotic and laparoscopic distal pancreatectomy, De Pastena The use of patient-reported outcome measures such as the QLQ-C30 and PAN26 questionnaires in pancreatic research has increased considerably over recent decades and is likely to continue expanding in importance in the future as treatments improve and focus moves from traditional clinical measurements to the physical and emotional well-being of patientsThis study has some limitations. First, it is based on the results of the QLQ-C30 and PAN26 questionnaires that were developed to evaluate symptoms among cancer and pancreatic cancer patients, respectively, and there were also patients with benign diagnoses in this study. However, these questionnaires have been widely used in the field of pancreatic surgery to evaluate postoperative quality of lifeSome strengths of the study were the high response rates to the questionnaires up to 2 years after surgery, and the fact that it was based on data from a RCT.