# Quality of Life After Pancreatic Surgery for Neuroendocrine Tumors of the Pancreas: Observational Study of Long-Term Outcomes

## TL;DR

This study finds that most patients who had surgery for pancreatic neuroendocrine tumors report a good quality of life, though older and diabetic patients experience worse outcomes.

## Contribution

The study introduces the use of new EORTC-specific questionnaires (P.NET15 and P.NET19) to evaluate quality of life in pancreatic neuroendocrine tumor patients.

## Key findings

- Patients showed a median quality of life score of 83.3/100 after a median of 133 months post-surgery.
- Older patients and those with diabetes had significantly worse quality of life outcomes.
- Non-insulinoma diagnosis and multiple comorbidities were linked to lower physical functioning and increased fatigue.

## Abstract

One hundred patients operated on for a pancreatic neuroendocrine tumor (1990–2023) received three EORTC questionnaires (QLQ-C30 and the new P.NET15 and P.NET19) to evaluate quality of life outcomes after surgery in relationship with clinical variables. After a median time of 133 months after surgery, patients showed a good QoL (median 83.3/100). Elderly and diabetic patients who underwent a standard pancreatic resection for a gastrinoma/non-functioning neuroendocrine tumor showed a significant worsening of QoL outcomes.

Background/Objectives: Patients with pancreatic neuroendocrine tumors (PanNETs) often have a good prognosis with long overall survival. We evaluated quality of life (QoL) after surgery for PanNETs, using the new EORTC-specific questionnaires. Methods: PanNET patients operated on in our unit (1990–2023) received three EORTC questionnaires (QLQ-C30 and the new P.NET15 and P.NET19). We evaluated the following: (1) QLQ-C30 outcomes; (2) mixed domains from QLQ-C30, P.NET15, and P.NET19; and (3) domains from P.NET19 and P.NET15 only. Functional and symptom scales were investigated in relationship with clinical variables. Gamma regression and multivariable analyses were performed with R software. Results: The 100 patients enrolled (median time 133 months after surgery) showed a good QoL (median 83.3/100). Old age was related to worse QoL and physical functioning (p = 0.007 and p < 0.001, respectively). Diabetes negatively influenced QoL (p < 0.001), physical functioning (p = 0.005), and fatigue (p = 0.03). Patients undergoing parenchyma-sparing surgery showed less fatigue (p = 0.046), while non-insulinoma PanNET diagnosis was related to worse QoL (p = 0.039). Multiple comorbidities were negatively associated with physical functioning (p = 0.010), fatigue (p = 0.001), and pain (p = 0.021). According to the new questionnaires, the most affected outcome was muscle energy, depending on age (p = 0.042), diabetes (p = 0.014), type of surgery (p = 0.018), and non-insulinoma diagnosis (p = 0.007). Conclusions: A good QoL evaluated with EORTC questionnaires is reported in PanNET patients after surgery. Elderly and diabetic patients who underwent standard resection for gastrinoma/non-functioning PanNETs showed worse QoL outcomes.