Clinical Science
Health-related quality of life changes following major and minor hepatic resection: the impact of complications and postoperative anemia

https://doi.org/10.1016/j.amjsurg.2013.02.011Get rights and content

Abstract

Background

Few studies have evaluated the health-related quality-of-life (QOL) changes in patients following major liver resection for malignancy.

Methods

QOL parameters were recorded prospectively at baseline (preoperative), and through 6 months of follow-up using various instruments.

Results

Major complications occurred in 10 of 41 patients. At the initial outpatient visit, patients reported decreased global QOL with increased fatigue compared with baseline, which normalized at 6 weeks' follow-up and remained stable at 6 months. Those with major complications reported increased severity of pain over baseline at initial follow-up and at 6 months. Patients anemic at the time of discharge had worse physical QOL at 6 weeks, but levels similar to nonanemic patients at 3 months.

Conclusions

Major complications are associated with increased reporting of pain persisting at 6 months. Attention to pain control, especially among patients with major complications, may improve QOL after major hepatic resection.

Section snippets

Methods

Patients with cancer of the liver who were scheduled for major resection were recruited for a prospective observational study of QOL before surgical treatment. The study protocol was approved by the institutional review board, and all patients provided written, informed consent.

Results

From March 2008 to February 2009, 41 patients were enrolled in this study. This included 22 men and 19 women with a median age of 60 years (range 36 to 83 years). All patients underwent major or minor hepatic resections, with the most common procedure being a right hepatic resection (Table 1).

After undergoing major liver resection, complications occurred in 14 (34%) patients, with major complications (grade ≥3) in 10 (24%) patients. Postoperative chemotherapy was administered in 17 (41%)

Comments

Although major hepatic resection has demonstrated its benefits in patients with both primary and metastatic malignancies, the changes in QOL should be considered. With the increasing demand for major hepatic resections, evaluating QOL effects after surgery has gained greater importance. Assessing QOL in surgical oncology patients has been limited primarily by the misleading notion that a surgeon's judgment is more reliable than QOL data. We are therefore finding increased importance in

Conclusions

Using different QOL measures, patients who experienced major complications following surgery reported increased severity of pain over baseline at initial follow-up and at 6 months. At the initial outpatient visit, patients reported decreased global QOL, physical functioning, role functioning, and social functioning, along with increased fatigue compared with baseline. For the FACT-An QOL scores, patients who were anemic at the time of discharge had a significantly worse physical QOL at 6 weeks

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    The authors declare no conflict of interest.

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