Abstract
Background
Esophagectomy has a potentially high impact on physical, emotional, and social functions. The aim of this study was to assess long-term health-related quality of life (QOL) after esophageal cancer surgery.
Methods
We analyzed all patients who underwent an Ivor Lewis esophagectomy for resectable esophageal cancer in our hospital from 1999 to 2010. QOL was assessed using the European Organization for Research and Treatment of Cancer general questionnaire QLQ-C30 and esophagus-specific questionnaire QLQ-OES18.
Results
A total of 150 patients were operated in the surveyed 12-year period. At the time of analysis, 46 patients (31 %) were eligible for assessment, 97 patients (65 %) had died or experienced tumor recurrence, and seven patients (5 %) were lost to follow-up. Of the 46 eligible patients, 43 (94 %) returned the questionnaires. The median observation interval between the operation and QOL assessment was 40 (range 21–135) months. The QLQ-C30 mean score of global health status and general QOL was similar to that of a healthy reference population. Most of the QLQ-C30 mean scores of functional and symptom scales and QLQ-OES18 symptom scales showed a worse result than for a healthy reference population. The highest mean scores were reflux and eating problems.
Conclusions
In the long term, Ivor Lewis esophagectomy provides a generally good QOL for patients with esophageal cancer, which is comparable to a healthy reference population. However, some patients suffer from significant symptoms. Reflux and eating problems were the most relevant complaints. Dietary counseling is therefore important in the postoperative course.
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References
Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46:765–781
Lagergren J, Lagergren P (2010) Oesophageal cancer. BMJ 341:c6280
Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317
Ariga H, Nemoto K, Miyazaki S et al (2009) Prospective comparison of surgery alone and chemoradiotherapy with selective surgery in resectable squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 75:348–356
Orringer MB (2011) Defining a “successful” esophagectomy. Ann Surg 253:6–7
Biere SS, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892
Mamidanna R, Bottle A, Aylin P et al (2012) Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 255:197–203
Lewis I (1945) Carcinoma of the oesophagus. Radical resection with oesophago-gastrostomy for a midthoracic growth by a right transpleural approach. Proc R Soc Med 39:483–484
Blazeby JM, Farndon JR, Donovan J et al (2000) A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 88:1781–1787
de Boer AG, van Lanschot JJ, van Sandick JW et al (2004) Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 22:4202–4208
Viklund P, Wengström Y, Rouvelas I et al (2006) Quality of life and persisting symptoms after oesophageal cancer surgery. Eur J Cancer 42:1407–1414
Avery KN, Metcalfe C, Barham CP et al (2007) Quality of life during potentially curative treatment for locally advanced oesophageal cancer. Br J Surg 94:1369–1376
McLarty AJ, Deschamps C, Trastek VF et al (1997) Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 63:1568–1572
Deschamps C, Nichols FC, Cassivi SD et al (2005) Long-term function and quality of life after esophageal resection for cancer and Barrett’s. Surg Clin North Am 85:649–656
Moraca RJ, Low DE (2006) Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer. Arch Surg 141:545–549 discussion 549–551
Courrech Staal EF, van Sandick JW, van Tinteren H et al (2010) Health-related quality of life in long-term esophageal cancer survivors after potentially curative treatment. J Thorac Cardiovasc Surg 140:777–783
Derogar M, Lagergren P (2012) Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol 30:413–418
Gockel I, Gönner U, Domeyer M et al (2010) Long-term survivors of esophageal cancer: disease-specific quality of life, general health and complications. J Surg Oncol 102:516–522
Djärv T, Lagergren J, Blazeby JM et al (2008) Long-term health-related quality of life following surgery for oesophageal cancer. Br J Surg 95:1121–1126
Donohoe CL, McGillycuddy E, Reynolds JV (2011) Long-term health-related quality of life for disease-free esophageal cancer patients. World J Surg 35:1853–1860
Gutschow CA, Hölscher AH, Leers J et al (2013) Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg 398:231–237
Siewert JR, Stein HJ (1998) Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 85:1457–1459
Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Blazeby JM, Alderson D, Winstone K et al (1996) Development of an EORTC questionnaire module to be used in quality of life assessment for patients with oesophageal cancer. Eur J Cancer 32:1912–1917
Blazeby JM, Conroy T, Hammerlid E et al (2003) Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer 39:1384–1394
Fayers PM, Aaronson NK, Bjordal K et al (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. EORTC, Brussels
Scott NW, Fayers PM, Aaronson NK et al (2008) EORTC QLQ-C30 reference values. EORTC, Brussels
Shibuya S, Fukudo S, Shineha R et al (2003) High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg 27:580–583
D’Journo XB, Martin J, Rakovich G et al (2009) Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition. Ann Surg 249:262–268
Bemelman WA, Verburg J, Brummelkamp WH et al (1988) A physical model of the intrathoracic stomach. Am J Physiol 254:G168–G175
Johansson J, Oberg S, Wenner J et al (2009) Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial. Ann Surg 250:667–673
Urschel JD, Blewett CJ, Young JE et al (2002) Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg 19:160–164
Cerfolio RJ, Bryant AS, Canon CL et al (2009) Is botulinum toxin injection of the pylorus during Ivor Lewis (corrected) esophagogastrectomy the optimal drainage strategy? J Thorac Cardiovasc Surg 137:565–572
Swanson EW, Swanson SJ, Swanson RS (2012) Endoscopic pyloric balloon dilatation obviates the need for pyloroplasty at esophagectomy. Surg Endosc 26:2023–2028
Donohoe CL, Reynolds JV (2014) Defining a successful esophagectomy. Ann Surg 259(5):e82
Martin L, Lagergren P (2009) Long-term weight change after oesophageal cancer surgery. Br J Surg 96:1308–1314
McKernan M, McMillan DC, Anderson JR et al (2008) The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesophageal cancer. Br J Surg 98:888–893
Acknowledgments
The authors would like to thank Dr. Fabio Nussberger for his help in data acquisition.
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The authors have no potential or real conflicts of interest.
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Däster, S., Soysal, S.D., Stoll, L. et al. Long-Term Quality of Life after Ivor Lewis Esophagectomy for Esophageal Cancer. World J Surg 38, 2345–2351 (2014). https://doi.org/10.1007/s00268-014-2576-1
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DOI: https://doi.org/10.1007/s00268-014-2576-1