Quality of Life After Esophagectomy

  • Melissa DeSouza
  • Claire L. Donohoe
  • James P. DolanEmail author


Health–related quality of life (HRQL) is a multi-dimensional concept that includes physical, emotional, mental, and social functioning. HRQL focuses on the impact of a disease state, or its treatment, on an individual’s subjective reporting of their ability to live a meaningful and quality lifestyle under the constraints of the disease or its treatment. Historically, the exceedingly high mortality and morbidity associated with esophagectomy prohibited any meaningful consideration of post-operative HRQL. Current treatment modalities have improved both perioperative outcomes and long-term survival. However, there is still a significant negative impact of treatment on HRQL. The most commonly encountered long-term issues related to HRQL after esophagectomy include diminished physical function, gastrointestinal disturbances, alterations in body composition, and impaired psychosocial reintegration.


Quality of life Esophagectomy Esophageal cancer Outcomes Well-being 


  1. 1.
    Dolan JP, McLaren PJ, Diggs BS, et al. Evolution in the treatment of esophageal disease at a Single Academic Institution: 2004–2013. J Laparoendosc Adv Surg Tech. 2017;27:915–23.CrossRefGoogle Scholar
  2. 2.
    Gavin A, Francisci S, Foschi R, et al. Oesophageal cancer survival in Europe: a EUROCARE-4 study. Cancer Epidemiol. 2012;36(6):505–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Shapiro J, van Lanschot JJB, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    (CDC) CfDCaP. Health-related quality of life (HRQOL) concepts. 2017. Accessed 18 Oct 2017.
  5. 5.
    (CDC) CfDCaP. Well-being concepts. 2017. Accessed 18 Oct 2017.
  6. 6.
    (FDA) UFaDA. Guidance for industry patient reported outcome measures: use in medical product development to support labeling claim. Fed Regist. 2009;74(35):65132–3.Google Scholar
  7. 7.
    Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA. 2012;307(15):1583–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Basch E. Patient-reported outcomes – harnessing patients’ voices to improve clinical care. N Engl J Med. 2017;376(2):105–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Jacobs M, Macefield R, Elbers R, et al. Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery. Qual Life Res. 2014;23(4):1155–76.CrossRefPubMedGoogle Scholar
  10. 10.
    McNair AG, Brookes ST, Whistance RN, et al. Trial outcomes and information for clinical decision-making: a comparative study of opinions of health professionals. Trials. 2016;17(1):344.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    McNair A, Brookes S, Kinnersley P, et al. What surgeons should tell patients with oesophago-gastric cancer: a cross sectional study of information needs. Eur J Surg Oncol (EJSO). 2013;39(11):1278–86.CrossRefGoogle Scholar
  12. 12.
    Thrumurthy S, Morris J, Mughal M, et al. Discrete-choice preference comparison between patients and doctors for the surgical management of oesophagogastric cancer. Br J Surg. 2011;98(8):1124–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Blazeby J, Macefield R, Blencowe N, et al. Core information set for oesophageal cancer surgery. Br J Surg. 2015;102(8):936–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Djarv T, Blazeby JM, Lagergren P. Predictors of postoperative quality of life after esophagectomy for cancer. J Clin Oncol. 2009;27(12):1963–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Djarv T, Lagergren P. Six-month postoperative quality of life predicts long-term survival after esophageal cancer surgery. Eur J Cancer. 2011;47(4):530–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Djarv T, Metcalfe C, Avery KN, et al. Prognostic value of changes in health-related quality of life scores during curative treatment for esophagogastric cancer. J Clin Oncol. 2010;28(10):1666–70.CrossRefPubMedGoogle Scholar
  17. 17.
    McKernan M, McMillan DC, Anderson JR, et al. The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesophageal cancer. Br J Cancer. 2008;98(5):888–93.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Healy LA, Ryan AM, Moore J, et al. Health-related quality of life assessment at presentation may predict complications and early relapse in patients with localized cancer of the esophagus. Dis Esophagus. 2008;21(6):522–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Noordman BJ, Verdam MGE, Lagarde SM, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, Busch OR, Ten Kate FJW, Creemers GM, Punt CJA, Plukker JTM, Verheul HMW, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJC, Rozema T, Biermann K, Beukema JC, Piet AHM, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A, Sprangers MAG, van Lanschot JJB. Effect of neoadjuvant chemoradiotherapy on health-related quality of life in esophageal or junctional cancer: results from the randomized CROSS trial. J Clin Oncol. 2018;36:268–75.CrossRefPubMedGoogle Scholar
  20. 20.
    Blazeby JM, Sanford E, Falk SJ, et al. Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer. 2005;103(9):1791–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Reynolds JV, McLaughlin R, Moore J, et al. Prospective evaluation of quality of life in patients with localized oesophageal cancer treated by multimodality therapy or surgery alone. Br J Surg. 2006;93(9):1084–90.CrossRefPubMedGoogle Scholar
  22. 22.
    Kauppila JH, Xie S, Johar A, et al. Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer. Br J Surg. 2017;104(9):1131–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Parameswaran R, Blazeby JM, Hughes R, et al. Health-related quality of life after minimally invasive oesophagectomy. Br J Surg. 2010;97(4):525–31.CrossRefPubMedGoogle Scholar
  24. 24.
    Maas KW, Cuesta MA, van Berge Henegouwen MI, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: results of a randomized trial. World J Surg. 2015;39(8):1986–93.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Viklund P, Lindblad M, Lagergren J. Influence of surgery-related factors on quality of life after esophageal or cardia cancer resection. World J Surg. 2005;29(7):841–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Scarpa M, Saadeh LM, Fasolo A, et al. Health-related quality of life in patients with oesophageal cancer: analysis at different steps of the treatment pathway. J Gastrointest Surg. 2013;17(3):421–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Gannon J, Guinan E, Doyle S, et al. Reduced fitness and physical functioning are long-term sequelae after curative treatment for esophageal cancer: a matched control study. Dis Esophagus. 2017;30(8):1.CrossRefPubMedGoogle Scholar
  28. 28.
    Guinan EM, Doyle SL, O’Neill L, et al. Effects of a multimodal rehabilitation programme on inflammation and oxidative stress in oesophageal cancer survivors: the ReStOre feasibility study. Support Care Cancer. 2017;25(3):749–56.CrossRefPubMedGoogle Scholar
  29. 29.
    Tatematsu N, Hasegawa S, Tanaka E, et al. Impact of oesophagectomy on physical fitness and health-related quality of life in patients with oesophageal cancer. Eur J Cancer Care. 2013;22(3):308–13.CrossRefGoogle Scholar
  30. 30.
    Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. Br J Surg. 2009;96(11):1308–14.CrossRefPubMedGoogle Scholar
  31. 31.
    Martin L, Jia C, Rouvelas I, et al. Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg. 2008;95(11):1362–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Donohoe C, Healy L, Fanning M, et al. Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction. Dis Esophagus. 2017;30(9):1–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Baker M, Halliday V, Williams RN, et al. A systematic review of the nutritional consequences of esophagectomy. Clin Nutr. 2016;35(5):987–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Audit NO-GC. Third annual report. NHS Information Centre: Leeds; 2010.Google Scholar
  35. 35.
    Bowrey DJ, Baker M, Halliday V, et al. A randomised controlled trial of six weeks of home enteral nutrition versus standard care after oesophagectomy or total gastrectomy for cancer: report on a pilot and feasibility study. Trials. 2015;16(1):531.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ludwig DJ, Thirlby RC, Low DE. A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure. Am J Surg. 2001;181(5):454–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Baba M, Aikou T, Natsugoe S, et al. Appraisal of ten-year survival following esophagectomy for carcinoma of the esophagus with emphasis on quality of life. World J Surg. 1997;21(3):282–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Haverkort E, Binnekade J, Busch O, et al. Presence and persistence of nutrition-related symptoms during the first year following esophagectomy with gastric tube reconstruction in clinically disease-free patients. World J Surg. 2010;34(12):2844–52.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Heneghan HM, Zaborowski A, Fanning M, et al. Prospective study of malabsorption and malnutrition after esophageal and gastric cancer surgery. Ann Surg. 2015;262(5):803–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Verschuur EM, Steyerberg EW, Kuipers EJ, et al. Experiences and expectations of patients after oesophageal cancer surgery: an explorative study. Eur J Cancer Care. 2006;15(4):324–32.CrossRefGoogle Scholar
  41. 41.
    McCorry NK, Dempster M, Clarke C, et al. Adjusting to life after esophagectomy: the experience of survivors and carers. Qual Health Res. 2009;19(10):1485–94.CrossRefPubMedGoogle Scholar
  42. 42.
    Wainwright D, Donovan JL, Kavadas V, et al. Remapping the body: learning to eat again after surgery for esophageal cancer. Qual Health Res. 2007;17(6):759–71.CrossRefPubMedGoogle Scholar
  43. 43.
    Watt E, Whyte F. The experience of dysphagia and its effect on the quality of life of patients with oesophageal cancer. Eur J Cancer Care Engl. 2003;12(2):183–93.CrossRefPubMedGoogle Scholar
  44. 44.
    Garratt AM, Ruta DA, Abdalla MI, et al. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ. 1993;306(6890):1440–4.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Aaronson NK, Ahmedzai S, Bergman B, et al. 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. 1993;85(5):365–76.CrossRefPubMedGoogle Scholar
  46. 46.
    Blazeby JM, Conroy T, Hammerlid E, et al. 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. 2003;39(10):1384–94.CrossRefPubMedGoogle Scholar
  47. 47.
    Darling G, Eton DT, Sulman J, et al. Validation of the functional assessment of cancer therapy esophageal cancer subscale. Cancer. 2006;107(4):854–63.CrossRefPubMedGoogle Scholar
  48. 48.
    Nakamura M, Hosoya Y, Umeshita K, et al. Postoperative quality of life: development and validation of the “dysfunction after upper gastrointestinal surgery” scoring system. J Am Coll Surg. 2011;213(4):508–14.CrossRefPubMedGoogle Scholar
  49. 49.
    Honda M, Wakita T, Onishi Y, et al. Development and validation of a symptom scale to evaluate postoperative patients with esophagogastric cancer. J Am Coll Surg. 2014;219(5):895–903.CrossRefPubMedGoogle Scholar
  50. 50.
    Honda M, Wakita T, Onishi Y, et al. Development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol. 2015;22(3):848–54.CrossRefGoogle Scholar
  51. 51.
    van Heijl M, Sprangers MA, de Boer AG, et al. Preoperative and early postoperative quality of life predict survival in potentially curable patients with esophageal cancer. Ann Surg Oncol. 2010;17(1):23–30.CrossRefPubMedGoogle Scholar
  52. 52.
    de Boer AG, van Lanschot JJ, van Sandick JW, et al. Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol. 2004;22(20):4202–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Noordman BJ, Verdam MG, Lagarde SM, et al. Effect of neoadjuvant chemoradiotherapy on health-related quality of life in esophageal or junctional cancer: results from the randomized CROSS trial. J Clin Oncol. 2017;73:7718.Google Scholar
  54. 54.
    Derogar M, Lagergren P. Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol. 2012;30(4):413–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Zieren H, Jacobi C, Zieren J, et al. Quality of life following resection of oesophageal carcinoma. Br J Surg. 1996;83(12):1772–5.CrossRefPubMedGoogle Scholar
  56. 56.
    Donohoe CL, McGillycuddy E, Reynolds JV. Long-term health-related quality of life for disease-free esophageal cancer patients. World J Surg. 2011;35(8):1853–60.CrossRefPubMedGoogle Scholar
  57. 57.
    Egberts JH, Schniewind B, Bestmann B, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life – a prospective, longitudinal outcome study. Ann Surg Oncol. 2008;15(2):566–75.CrossRefPubMedGoogle Scholar
  58. 58.
    Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222(5):654.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Melissa DeSouza
    • 1
  • Claire L. Donohoe
    • 1
  • James P. Dolan
    • 1
    Email author
  1. 1.Division of Gastrointestinal and General SurgeryOregon Health and Science UniversityPortlandUSA

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