Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer

doi:10.1016/j.ejca.2015.05.006

European Journal of Cancer

Volume 51, Issue 12, August 2015, Pages 1538-1545

https://doi.org/10.1016/j.ejca.2015.05.006 Get rights and content

Abstract

Background

Gaining insight in long-term health-related quality of life more than 1 year after oesophagectomy will assist clinical decision-making and inform patients about the long-term consequences of surgery.

Methods

In this cross-sectional study, all consecutive patients who underwent oesophageal resection with gastric interposition for cancer at a tertiary referral centre between January 2007 and July 2012 were included. European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 and QLQ-OES18 were sent to all patients alive without recurrence more than 1 year after surgery.

Results

The questionnaires were completed by 92 of 100 patients. Median duration of follow-up after surgery at completing the questionnaire was 36 months (range: 12–75). Global quality of life scores were similar to a general population reference group (76 ± 19 versus 78 ± 17; p = 0.26). However, patients scored significantly worse compared to the general population reference group on physical-, role-, cognitive- and social functioning (p < 0.001). Neoadjuvant therapy and minimally invasive oesophagectomy were associated with significantly better health-related quality of life (HRQL) and symptom scores (p < 0.05).

Conclusion

Global HRQL more than 1 year after oesophagectomy with gastric tube reconstruction is comparable to the general Dutch background population, while specific functional and symptom scores are significantly worse. Neoadjuvant therapy and minimally invasive surgery are associated with quality of life benefits in long-term survivors.

Introduction

Treatment with curative intent for oesophageal cancer consists of surgical resection, generally combined with neoadjuvant chemo(radio)therapy. Recent studies report increased 5-year survival rates of up to 49% for patients with resectable disease [1], [2], [3]. Consequently, it is important to focus on a reduction of postoperative morbidity and improve health-related quality of life (HRQL) after oesophagectomy. Gaining insight in risk factors for impaired HRQL after oesophagectomy will assist clinical decision-making and inform patients about the long-term consequences of surgery. Previous research has shown contradictory results regarding HRQL more than 1 year after oesophagectomy [4], [5], [6], [7], [8], [9]. This cross-sectional study aims to evaluate HRQL and predictive factors from 1 year onwards after oesophagectomy with gastric interposition in patients with oesophageal cancer.

Section snippets

Materials and methods

A descriptive cross-sectional study was carried out at our tertiary referral centre. The study was approved by the institutional review board and informed consent was obtained from all patients. All consecutive patients who underwent oesophageal resection with gastric interposition for cancer between January 2007 and July 2012 were included. Deceased patients and patients with recurrent or metastatic disease were excluded. Health-related quality of life questionnaires (European Organization for

Results

In total, 214 patients underwent oesophagectomy with gastric tube interposition in the studied period. About half (n = 110) of these patients were excluded due to mortality, locoregional recurrence or disseminated disease at time of analysis. Another three patients could not be reached despite repeated efforts. Only one patient refused to participate. The remaining 100 patients were included and questionnaires were sent by postal mail.

Discussion

This cross-sectional study indicates that global HRQL in long-term survivors after oesophagectomy for oesophageal cancer is comparable to the general Dutch background population. Specific functioning scores, however, are significantly worse in long-term survivors. Follow-up from 1 year after surgery onwards was not related to quality of life scores, suggesting a relatively stable quality of life in patients without recurrent disease after the first year. Neoadjuvant therapy was associated with

Conflict of interest statement

None declared.

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Surgery, as part of a multimodal approach, offers the greatest chance of cure for esophageal cancer. However, esophagectomy is often perceived as having a lasting impact on quality of life (QOL), biasing some physicians and patients toward nonoperative management. A comprehensive understanding of the dynamic changes in patient-centered outcomes is therefore important for decision making. Our objective was to determine the long-term QOL after esophagectomy.
Data were obtained from a prospectively collected (2006-2015) esophagectomy database at a high-volume center, and patients surviving 3 or more years were identified. Health-related QOL was evaluated using the Functional Assessment of Cancer Therapy-Esophageal Module (FACT-E) at diagnosis and every 3 to 6 months, and was stratified according to operative approach, stage, and complications. In addition, QOL scores were compared with normative population values.
Of 480 patients, 47% (n = 226) survived 3 or more years and 70% (158 of 226) completed the health-related QOL assessments. Time of follow-up was 5.1 ± 2.8 years. After a reduction at 1 to 3 months, FACT-E increased from a baseline of 126 (95% CI, 121-131) to 133 (95% CI, 127-139) at 12 months, and to 147 (95% CI, 142-153) by 5 years. There was no difference in long-term FACT-E with respect to the surgical approach, clinical and pathologic stage, or postoperative complications. At long-term follow-up (more than 3 years), QOL did not differ significantly from the normative population reference values.
The long-term QOL of esophagectomy patients surviving at least 3 years is improved when compared with the time of diagnosis and does not differ from the general population.
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Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conflict of interest statement

J Thorac Cardiovasc Surg

Eur J Cancer

Eur J Cancer

Eur J Cancer

Lancet

Lancet Oncol

Preoperative chemoradiotherapy for esophageal or junctional cancer

N Engl J Med

Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial

Ann Surg

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

Br J Cancer

Health-related quality of life after Ivor Lewis esophagectomy

Langenbecks Arch Surg

Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study

J Clin Oncol