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Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy

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Abstract

Background

The good short-term and oncological outcomes of robot-assisted radical esophagectomy have been demonstrated, although its impact on long-term health-related quality of life (HRQoL) remains to be investigated. This study aimed to assess long-term HRQoL in patients after robot-assisted radical transmediastinal esophagectomy (TME), which is characterized as non-transthoracic esophagectomy comprising a robotic transhiatal approach and a video-assisted cervical approach, and transthoracic esophagectomy (TTE).

Methods

The European Organization for Research and Treatment of Cancer generic and disease-specific modules (QLQ-C30 and QLQ-OES18), nutritional status and body composition data were prospectively collected in patients undergoing TME or TTE before and at 3, 6, 12, 18, and 24 months after surgery. The results of long-term (≥ 2 years) survivors without recurrence were compared between the two groups.

Results

A total of 37 patients (TME; n = 18, TTE; n = 19) were included for analysis. Longitudinal survey of function scales revealed scores of physical, role, social, and emotional function to be significantly better in the TME group than in the TTE group at many points postoperatively. Markedly, the symptoms of general pain, esophageal pain, and dry mouth greatly worsened after surgery in the TTE group, but did not deteriorate in the TME group. In contrast, symptoms relating to eating difficulties, body composition data, and nutritional status did not differ between the groups over time. At 24 months after surgery, TME provided significantly higher scores of global QOL (P = 0.01) and emotional function (P = 0.01) and also resulted in significantly fewer problems of fatigue (P = 0.04), general pain (P = 0.04), insomnia (P = 0.02), and dry mouth (P = 0.03), as compared to TTE.

Conclusion

This study indicates that TME can provide better long-term HRQoL outcomes than TTE.

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Abbreviations

CCI:

Charlson comorbidity index

EC:

Esophageal carcinoma

EORTC:

European Organization for Research and Treatment of Cancer

HRQoL:

Health-related quality of life

LN:

Lymph node

MIE:

Minimally invasive surgery

RAMIE:

Robot-assisted minimally invasive esophagectomy

THE:

Transhiatal esophagectomy

TME:

Transmediastinal esophagectomy

TTE:

Transthoracic esophagectomy

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kotaro Sugawara, Shuntaro Yoshimura, Koichi Yagi, Masato Nishida, Susumu Aikou, Hiroharu Yamashita & Yasuyuki Seto

  2. Department of Bariatric & Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Susumu Aikou

  3. Department of Gastric Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan

    Yukinori Yamagata

  4. Department of Gastrointestinal Surgery, Mitsui Memorial Hospital, Tokyo, Japan

    Kazuhiko Mori

Authors
  1. Kotaro Sugawara
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Correspondence to Yasuyuki Seto.

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Disclosures

The contributions of the authors to this study are as follows: Kotaro Sugawara, Shuntaro Yoshimura, and Yasuyuki Seto are the authors mainly responsible for the study’s conception and design, acquisition of data, and analysis and interpretation of data. Koichi Yagi, Masato Nishida, Susumu Aikou, Yukinori Yamagata, Kazuhiko Mori and Hiroharu Yamashita contributed mainly to the drafting of the article and to revising it critically for important intellectual content. Drs. Kotaro Sugawara, Shuntaro Yoshimura, Koichi Yagi, Masato Nishida, Susumu Aikou, Yukinori Yamagata, Kazuhiko Mori, Hiroharu Yamashita, and Yasuyuki Seto have no conflicts of interest or financial ties to disclose.

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Sugawara, K., Yoshimura, S., Yagi, K. et al. Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy. Surg Endosc 34, 1602–1611 (2020). https://doi.org/10.1007/s00464-019-06923-7

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