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Learning curve in relation to health-related quality of life in long-term, disease free survivors after McKeown minimally invasive esophagectomy

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Abstract

Background

The potential impact of learning curve on long-term health-related quality of life (QoL) after esophagectomy for cancer has not been investigated. The aim of this article is to investigate the relationship between learning curve for McKeown minimally invasive esophagectomy (MIE) and health-related quality of life (QoL) in long-term, disease free survivors up to 10 years after esophageal cancer resection.

Methods

Esophageal cancer patients who underwent McKeown MIE between 2009 and 2019 were identified in which 280 who were free of disease at the time of survey and completed health-related QoL and symptom questionnaires, including EORTC QLQ-C30, EORTC QLQ-OES18, and Digestive Symptom Questionnaire. Patients were assessed in 3 cohorts according to the learning phases of expertise reported by our previous study: initial phase; plateau phase, and; experienced phase.

Results

Median time from operation to survey was 5.8 years (interquartile range 4.6–8.2). The QLQ-C30 mean scores of functional scales, and symptom scales of respiratory and digestive systems including dyspnea (P = 0.006), shortness of breath (P = 0.003), and dysphagia (P = 0.031) were significantly better in experienced phase group. Furthermore, in the subgroup analyses for patients without postoperative major complications, patients in the initial learning phase remained suffering from more symptoms of dyspnea (P = 0.040) and shortness of breath (P = 0.001).

Conclusion

Esophageal cancer patients undergoing McKeown MIE in initial learning phase tend to suffer from a deterioration in long-term health-related QoL and higher symptomatic burden as compared to experienced learning phase, which did not improved over time and warranted more attention.

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Authors and Affiliations

  1. Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People’s Republic of China

    Tao Bao, Xian-Dong He & Wei Guo

  2. Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People’s Republic of China

    Tao Bao, Ping Chen, Jun Yu, Dao-Hong Cai, Xian-Dong He, Ying-Jian Wang, Xian-Feng Xie, Kun-Kun Li, Xiao-Ying Zhao & Wei Guo

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  1. Tao Bao
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Contributions

WG, XYZ and TB conceived and designed the experiments. TB, PC, JY, DHC, XDH, YJW, XFX and KKL recorded the follow-up data. TB, PC and JY analyzed the data. TB wrote the manuscript. TB, PC and JY contributed equally to this work and should be considered the co-first authors.

Corresponding author

Correspondence to Wei Guo.

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Disclosures

Tao Bao, Ping Chen, Jun Yu, Dao-Hong Cai, Xian-Dong He, Ying-Jian Wang, Xian-Feng Xie, Kun-Kun Li, Xiao-Ying Zhao and Wei Guo have no conflicts of interest or financial ties to disclose.

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Bao, T., Chen, P., Yu, J. et al. Learning curve in relation to health-related quality of life in long-term, disease free survivors after McKeown minimally invasive esophagectomy. Surg Endosc 38, 671–678 (2024). https://doi.org/10.1007/s00464-023-10553-5

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