Longitudinal Symptom Recovery After Pancreatectomy: A Prospective Patient-Reported Outcomes Study using MDASI

BACKGROUND: Detailed longitudinal data on symptom recovery after pancreatectomy and determinants of delayed recovery remain limited. This study prospectively characterized symptom trajectories and defined symptom-based recovery using patient-reported outcomes. METHODS: The study included 185 patients who underwent pancreatectomy between October 2020 and September 2025 (pancreatoduodenectomy [n = 106], distal pancreatectomy [n = 79]). Of the 185 patients, 121 (65%) underwent a robotic approach. The MD Anderson Symptom Inventory (MDASI) was completed preoperatively at seven postoperative time points through postoperative month (POM) 6. The top five symptoms and top three interference items were identified using mean postoperative day 3 scores. Composite symptom and interference scores were defined as the mean scores of those top items for each. Recovery was defined when both composite scores achieved ≤ 3 of 10 points. Cumulative recovery rates were compared by surgery type and approach, and cluster analysis was performed to identify patients with delayed recovery and contributing factors. RESULTS: The top symptoms were pain, fatigue, sleep disturbance, drowsiness, and bloating, and the top interference items were general activity, working, and walking. Symptom recovery followed three phases: acute improvement (POD 3 to 14), a plateau (POD 14 to POM 1), and persistent recovery extending to POM 6. Fatigue persisted longest. Overall cumulative recovery rates were 68.1% on POM 1, 78.6% on POM 3, and 86.9% on POM 6. In cluster analysis, postoperative complications predicted delayed recovery, whereas surgery type and approach did not. CONCLUSIONS: Early symptom burden improved over time, with changes varying by time point, but fatigue often persisted. Prevention of postoperative complications appears to be a key strategy for improving symptom recovery regardless of surgical approach.