Background

Patients with familial adenomatous polyposis (FAP) carry a risk of duodenal adenocarcinoma. These patients, who already have an ileal pouch-anal anastomosis (IPAA), sometimes require pancreaticoduodenectomy (PD). This work aims to evaluate the long-term consequences of the combination of PD + IPAA.

Methods

All patients with IPAA due to FAP who underwent PD from 1991 to 2017 were included (PD + IPAA group). Patients were matched 1:1 according to age, sex, ASA score and presence of colorectal cancer. Fecal continence and quality of life (QoL) were assessed using the Wexner score and the EORTC-QLQ-C30 questionnaire.

Results

Thirty-two PD + IPAA patients were matched with thirty-two IPAA-only patients. In each group, the response rate to the questionnaire was 78% (25/32). No differences were noted between PD + IPAA and IPAA-only groups in terms of daytime fecal frequency (6.0 vs 6.0; p = 0.362), Wexner score (3/20 vs 4/20; p = 0.984) and global QoL score (83.3/100 vs 83.3/100; p = 0.401). In the PD + IPAA group, 26% of patients developed diabetes a median period of 10.0 years after PD. The global QoL for these patients was significantly altered (p = 0.011), while daytime fecal frequency was unaffected (p = 0.092) as fecal continence (p = 0.475).

Conclusion

In FAP patients with IPAA, PD does not affect bowel function or QoL.

中文翻译：

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胰十二指肠切除术对家族性腺瘤性息肉病回肠储袋肛门吻合术患者肠道功能和生活质量的十年影响。

背景

家族性腺瘤性息肉病 (FAP) 患者有患十二指肠腺癌的风险。这些已经进行回肠储袋-肛门吻合术 (IPAA) 的患者有时需要胰十二指肠切除术 (PD)。这项工作旨在评估 PD + IPAA 组合的长期后果。

方法

包括1991年至2017年期间接受PD的所有FAP所致IPAA患者（PD+IPAA组）。患者根据年龄、性别、ASA 评分和结直肠癌的存在按 1:1 匹配。使用 Wexner 评分和 EORTC-QLQ-C30 问卷评估大便控制和生活质量 (QoL)。

结果

三十二名 PD + IPAA 患者与三十二名仅使用 IPAA 的患者相匹配。在每组中，对问卷的答复率为 78% (25/32)。在白天排便频率（6.0 对 6.0；p = 0.362）、Wexner 评分（3/20 对 4/20；p = 0.984）和全球 QoL 评分（83.3）方面，PD + IPAA 组和仅 IPAA 组之间没有差异/100 对 83.3/100；p = 0.401）。在 PD + IPAA 组中，26% 的患者在 PD 后的中位时间为 10.0 年发展为糖尿病。这些患者的总体 QoL 显着改变 (p = 0.011)，而白天排便频率不受影响 (p = 0.092)，因为大便控制 (p = 0.475)。

结论

在患有 IPAA 的 FAP 患者中，PD 不影响肠道功能或 QoL。