Background
Methods
Search strategies
Inclusion and exclusion criteria
Data extraction
Interested outcomes
Statistical analysis
The first author | Study design | Risk of bias | ||||||
---|---|---|---|---|---|---|---|---|
Sequence generation | Allocation concealment | Blinding patient/personnel | Incomplete outcome data | Blinding outcome | Selective outcome reporting | Other source of bias | ||
Barbour et al. [17] | Cohort | High | High | High | Unclear | High | Low | Low |
Wang et al. [19] | Cohort | High | High | High | Unclear | High | Low | Low |
Maas et al. [20] | RCT | Low | High | High | Low | High | Low | Low |
Wang et al. [15] | Cohort | High | High | High | Unclear | High | Low | Low |
Parameswaran et al. [16] | Case series | N/A | N/A | N/A | N/A | High | Low | Low |
Nafteux et al. [18] | Cohort | High | High | High | Unclear | High | Low | High |
Results
Selected studies
Characteristics of studies and patients
Study | Year | Country | Center | Randomized | Prospective data | Consecutive | HRQL as primary outcome | Preoperative HRQL assessment | SF36 | OES18 | QLQ C30 | Timing HRQL measures |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Barbour et al. [17] | 2016 | Australia | Princess Alexandra Hospital | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Baseline, 3,6,9,12,18,24 mo po |
Wang et al. [19] | 2015 | China | Zhongshan Hospital | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Baseline, 1, 3,6,12,18,24 mo po |
Maas et al. [20] | 2015 | Netherlands | VU University Medical Center | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Baseline, 1.5, 12 mon po |
Wang et al. [15] | 2010 | China | Zhongshan Hospital | No | No | Yes | Yes | Yes | No | Yes | Yes | Baseline, 0.5, 1, 4 6 mon po |
Parameswaran et al. [16] | 2010 | UK | Royal Devon and Exeter NHS Foundation Trust | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Baseline, 1.5, 3, 6, 12 mon po |
Nafteux et al. [18] | 2011 | Belgium | UZ Gasthuisberg | No | Yes | Yes | Yes | Yes | No | Yes | Yes | Baseline, 1–3, 4–6, 10–12 mon po |
Study | Recruitment period | Intervention | Cases | M/F | Median/mean age (range) | Pathology (adeno/SCC/other) | TNM stage | Tumor site (U/M/L/GEJ) | ASA grade | Mean/median follow up (months) | Neoadjuvant treatment (no/CT/CRT) |
---|---|---|---|---|---|---|---|---|---|---|---|
Barbour et al. [17] | 1988–2011 | TAMK | 377 | 316/61 | 64 (27–84) | 299/78/0 | 51/80/125/121/0(0/I/II/III/IV) | 0/42/299/36 | 275/102 (1&2/3&4) | 27 | 175/87/115 |
Wang et al. [19] | 2004–2013 | MIE † | 444 | 362/82 | 56 (32–77) | 0/444/0 | 62/254/100/28 (0&I/II/III/IV) | 63/244/137/0 | 321/107/16 (1/2/3) | 27 | 364/22/58 |
Maas et al. [20] | 2009–2011 | MIE † | 59 | 43/16 | 62 (34–75) | 35/24/0 | 1/4/26/11/4/9/4 (0/I/II/III/IV/No residual tumor of LN. matas./no surgery) | N/A | 10/34/14/1 (1/2/3/4) | 12 | 0/5/54 |
Wang et al. [15] | 2007–2008 | MIE ‡ | 27 | 19/8 | 60.7 ± 9.3 | 1/25/1 | 6/14/4/3/0 (0&I/IIa/IIb/III/IV) | 4/17/6//0 | N/A | 6 | 27/0/0 |
Parameswaran et al. [16] | 2005–2007 | MIE ‡ | 62 | 56/6 | 67 (49–80) | 55/5/2 | 3/7/21/27/4 (0/I/II/III/IV) | N/A | N/A | 12 | 0/48/0 |
Nafteux et al. [18] | 2005–2010 | MIE ‡ | 65 | 52/13 | 63.1(41–82) | 52/N/A/13 | 10/55/0/0/0 (0/I/II/III/IV) | N/A | N/A | 72 | 65/0/0 |
HRQL change
Baseline vs. 3 months | Baseline vs. 6 months | Baseline vs. 12 months | Baseline vs. 24 months | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Patients† | MD | Heterogeneity | Patients† | MD | Heterogeneity | Patients† | MD | Heterogeneity | Patients† | MD | Heterogeneity | |||||||||
(groups) | (clinical relevance) | Tau2 | Chi 2 | I2(%) | (groups) | (clinical relevance) | Tau2 | Chi 2 | I2(%) | (groups) | (clinical relevance) | Tau2 | Chi 2 | I2(%) | (groups) | (clinical relevance) | Tau2 | Chi 2 | I2(%) | |
Physical function ‡ | 1753 | -14.36 [-11.77, -16.95] | 2.88 | P=0.09 | 58 | 1841 | -9.32 [-5.36, -13.28] | 11.17 | P=0.001 | 81 | 1787 | -7.42 [-4.80, -10.03] | 3.29 | P=0.10 | 53 | 1489 |
-4.31 [-3.27, -5.36]
|
1.87
|
P=0.17
|
46
|
3 | Medium | 4 | Small | 4 | Small | 2 |
Trivial
| |||||||||||||
Role function ‡ | 919 | -18.55 [-3.14, -33.97] | 175.01 | P<0.00001 | 95 | 1007 | -10.01 [3.93, -23.94] | 187.29 | P<0.00001 | 95 | 899 | -9.07 [0.04, -18.18] | 48.02 | P=0.01 | 77 | N/A | N/A | N/A | N/A | N/A |
3 | Medium | 4 | Small | 3 | Small | |||||||||||||||
Emotional function ‡ | 919 | 0.83 [8.45, -6.79] | 36.33 | P=0.003 | 82 | 1007 | 3.47 [8.88, -1.94] | 19.65 | P=0.02 | 68 |
899
|
2.05 [6.05, -1.95]
|
1.78
|
P=0.32
|
11
| N/A | N/A | N/A | N/A | N/A |
3 | Trivial | 4 | Trivial |
3
|
Trivial
| |||||||||||||||
Cognitive function ‡ | 919 | -3.78 [4.16, -11.71] | 41.8 | P=0.0003 | 88 | 1007 | -2.02 [5.32, -9.36] | 46.43 | P<0.0001 | 87 | 899 | -4.14 [2.29, -10.57] | 19.97 | P=0.07 | 62 | N/A | N/A | N/A | N/A | N/A |
3 | Small | 4 | Small | 3 | Small | |||||||||||||||
Social function ‡ | 919 | -11.31 [4.43, -27.05] | 183.61 | P<0.00001 | 95 | 1007 | -4.38 [8.20, -16.97] | 149.24 | P<0.00001 | 93 | 911 | -6.56 [2.03, -15.14] | 41.72 | P=0.02 | 75 | N/A | N/A | N/A | N/A | N/A |
3 | Medium | 4 | Trivial | 3 | Trivial | |||||||||||||||
Global QoL ‡ |
1753
|
-7.26 [-5.88, -8.64]
|
3.85
|
P=0.15
|
48
|
1740
|
-4.94 [-2.95, -6.94]
|
1.04
|
P=0.25
|
28
| 1758 | -0.52 [4.67, -5.72] | 21.2 | P=0.0002 | 85 | 1489 |
0.11 [1.58, -1.36]
|
1.37
|
P=0.24
|
27
|
3
|
Small
|
3
|
Trivial
| 4 | Trivial | 2 |
Trivial
| |||||||||||||
Dyspnea ‡ | 1753 | -12.06 [-15.97, -8.15] | 7.67 | P=0.02 | 74 | 1740 | -10.48 [-15.13, -5.84] | 12.28 | P=0.003 | 83 | 1692 | -8.98 [-13.20, -4.76] | 9.56 | P=0.01 | 77 | 1489 | -6.37 [-7.23, -5.52] | 2.87 | P=0.09 | 65 |
3 | Medium | 3 | Small | 3 | Small | 2 | Small | |||||||||||||
Pain ‡ | 1753 | -13.85 [-17.30, -10.40] | 5.81 | P=0.05 | 67 | 1845 | -11.36 [-14.48, -8.23] | 4.82 | P=0.09 | 53 | 1853 | -5.04 [-10.96, 0.87] | 33.42 | P<0.00001 | 86 | 1489 | -5.76 [-12.71, 1.18] | 23.29 | P=0.0003 | 92 |
3 | Medium | 4 | Small | 5 | Small | 2 | Small | |||||||||||||
Fatigue ‡ | 1753 | -20.60 [-24.12, -17.08] | 5.74 | P=0.06 | 64 | 1841 | -13.68 [-19.58, -7.78] | 26.49 | P=0.0001 | 86 | 1787 | -9.27 [-15.27, -3.27] | 27.38 | P=0.0001 | 85 | 1489 | -6.48 [-10.74, -2.21] | 7.79 | P=0.02 | 80 |
3 | Large | 4 | Medium | 4 | Small | 2 | Small | |||||||||||||
Insomnia ‡ |
919
|
-7.64 [-11.52, -3.76]
|
2.53
|
P=0.28
|
21
|
906
|
-4.48 [-8.34, -0.63]
|
P=0.22
|
35
|
852
|
-5.82 [-10.08, -1.56]
|
0.05
|
P=0.82
|
0
| N/A | N/A | N/A | N/A | N/A | |
3
|
Small
|
3
|
Small
|
2
|
Small
| |||||||||||||||
Anorexia ‡ | 919 | -18.36 [-32.27, -4.45] | 129.55 | P=0.0005 | 87 | 1007 | -6.71 [-16.85, 3.43 | 87.85 | P=0.0002 | 85 |
899
|
-4.29 [-9.73, 1.15]
|
8.92
|
P=0.21
|
36
| N/A | N/A | N/A | N/A | N/A |
3 | Medium | 4 | Small |
3
|
Small
| |||||||||||||||
Nausea and Vomiting ‡ | 919 | -10.43 [-19.51, -1.35] | 56.71 | P<0.0001 | 91 | 1007 | -6.06 [-13.10, 0.97] | 41.88 | P<0.0001 | 86 | 899 | -5.20 [-12.20, 1.81] | 28.32 | P=0.02 | 75 | N/A | N/A | N/A | N/A | N/A |
3 | Small | 4 | Small | 3 | Trivial | |||||||||||||||
Constipation ‡ |
919
|
-4.27 [-7.21, -1.33]
|
1.48
|
P=0.48
|
0
|
1243
|
-5.42 [-8.26, -2.58]
|
3.22
|
P=0.20
|
38
|
804
|
-3.10 [-6.31, 0.10]
|
P=0.90
|
0
| N/A | N/A | N/A | N/A | N/A | |
3
|
Trivial
|
3
|
Small
|
2
|
Trivial
| |||||||||||||||
Diarrhea ‡ | 919 | -12.42 [-20.99, -3.85] | 43.7 | P=0.01 | 77 | 906 | -13.44 [-23.53, -3.34] | 65.62 | P=0.002 | 84 |
804
|
-12.69 [-15.97, -9.41]
|
P=0.40
|
0
| N/A | N/A | N/A | N/A | N/A | |
3 | Small | 3 | Small |
2
|
Small
| |||||||||||||||
Financial ‡ |
169
|
-7.18 [-13.71, -0.65]
|
1.06
|
P=0.30
|
6
|
167
|
-6.51 [-13.31, 0.29]
|
P=0.24
|
29
| N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
2
|
Small
|
2
|
Small
| |||||||||||||||||
Dysphagia § | 919 | 6.70 [-17.38, 30.77] | 440.55 | P<0.00001 | 98 | 1007 | 7.11 [-12.89, 27.10] | 398.73 | P<0.00001 | 97 | 899 | -4.51 [-14.17, 5.14] | 57.58 | P=0.005 | 81 | N/A | N/A | N/A | N/A | N/A |
3 | Small | 4 | Small | 3 | Trivial | |||||||||||||||
Eating Problem § | 919 | -5.85 [-34.21, 22.50] | 616.02 | P<0.00001 | 98 | 1007 | -0.94 [-21.86, 19.97] | 440.12 | P<0.00001 | 97 | 899 | -3.51 [-12.05, 5.04] | 43.43 | P=0.01 | 78 | N/A | N/A | N/A | N/A | N/A |
3 | Small | 4 | Trivial | 3 | Trivial | |||||||||||||||
Reflux § | 804 | -14.01 [-39.88, 11.86] | 339.53 | P<0.00001 | 97 | 915 | -5.21 [-19.44, 9.01] | 148.13 | P<0.00001 | 95 |
788
|
-3.25 [-6.87, 0.37]
|
P=0.72
|
0
| N/A | N/A | N/A | N/A | N/A | |
2 | Medium | 3 | Trivial |
2
|
Trivial
| |||||||||||||||
Pain-OES18 § | 804 | 0.46 [-3.91, 4.84] | 6.49 | P=0.09 | 64 | 896 | 2.13 [-2.65, 6.92] | 11.24 | P=0.05 | 66 |
788
|
0.31 [-3.08, 3.69]
|
1.14
|
P=0.29
|
9
| N/A | N/A | N/A | N/A | N/A |
2 | Trivial | 3 | Trivial |
2
|
Trivial
| |||||||||||||||
Swallowing problem § | 919 | -6.36 [-14.87, 2.15] | 45.68 | P=0.003 | 83 | 906 | -5.05 [-13.39, 3.29] | 43.04 | 0.005 | 81 | 804 | -6.40 [-17.92, 5.12] | 61.41 | P=0.004 | 88 | N/A | N/A | N/A | N/A | N/A |
3 | Small | 3 | Small | 2 | Trivial | |||||||||||||||
Dry mouth § | 919 | -5.82 [-11.64, -0.01] | 13.73 | P=0.13 | 51 | 906 | -5.66 [-12.38, 1.06] | 22.69 | P=0.06 | 65 |
804
|
-9.19 [-13.24, -5.13]
|
P=0.30
|
5
| N/A | N/A | N/A | N/A | N/A | |
3 | Small | 3 | Small |
2
|
Small
| |||||||||||||||
Taste problem § | 919 | -10.26 [-26.13, 5.61] | 181.5 | P<0.00001 | 93 | 906 | -6.75 [-16.15, 2.65] | 54.91 | P=0.006 | 81 |
804
|
-8.42 [-12.46, -4.38]
|
P=0.28
|
14
| N/A | N/A | N/A | N/A | N/A | |
3 | Medium | 3 | Small |
2
|
Small
| |||||||||||||||
Cough problem § | 919 | -15.35 [-25.20, -5.50] | 56.49 | P=0.02 | 76 | 906 | -12.05 [-23.21, -0.88] | 78.64 | P=0.004 | 82 | 804 | -11.01 [-18.89, -3.13] | 19.56 | P=0.13 | 55 | N/A | N/A | N/A | N/A | N/A |
3 | Medium | 3 | Medium | 2 | Medium | |||||||||||||||
Speech problem § |
919
|
-9.94 [-12.68, -7.20]
|
P=0.15
|
48
|
906
|
-8.45 [-11.07, -5.84]
|
1.9
|
P=0.39
|
0
| 870 | -3.16 [-9.25, 2.92] | 17.59 | P=0.08 | 60 | N/A | N/A | N/A | N/A | N/A | |
3
|
Small
|
3
|
Small
| 3 | Trivial |
Primary outcomes
HRQL outcome | HRQL change at 3-month follow-up | HRQL change at 3-, 6–12-,and/or 24 month follow-ups | ||||
---|---|---|---|---|---|---|
Number of patients† (Groups) | Amount of heterogeneity‡ | Direction of HRQL change§,¶ | Clinical relevance of HRQL change\\,†† | Direction of HRQL change§,¶,‡‡ | Duration of HRQL change§§ | |
Physical function | 1753 (3) | Substantial | Deterioration | Unclear | Deterioration | Unclear |
Role function | 919 (3) | Considerable | Deterioration | Unclear | Unclear | Unclear |
Emotional function | 919 (3) | Considerable | Unclear | Unclear | No change | No change |
Cognitive function | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Social function | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Global QoL | 1753 (3) | Moderate | Deterioration | Small | Deterioration | 6 months |
Dyspnea | 1753 (3) | Substantial | Increase | Unclear | Increase | Unclear |
Pain | 1753 (3) | Substantial | Increase | Unclear | Increase | Unclear |
Fatigue | 1753 (3) | Substantial | Increase | Unclear | Increase | Unclear |
Insomnia | 919 (3) | Low | Increase | Small | Increase | >12 months¶¶ |
Anorexia | 919 (3) | Considerable | Increase | Unclear | Unclear | Unclear |
Nausea and Vomiting | 919 (3) | Considerable | Increase | Unclear | Unclear | Unclear |
Constipation | 919 (3) | Low | Increase | Trivial | Increase | 12 months |
Diarrhea | 919 (3) | Considerable | Increase | Unclear | Increase | Unclear |
Financial | 169 (2) | Low | Increase | Small | N/A | N/A |
Dysphagia | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Eating Problem | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Reflux | 804 (2) | Considerable | Unclear | Unclear | Unclear | Unclear |
Pain-OES18 | 804 (2) | Substantial | Unclear | Unclear | Unclear | Unclear |
Swallowing problem | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Dry mouth | 919 (3) | Substantial | Increase | Unclear | Unclear | Unclear |
Taste problem | 919 (3) | Considerable | Unclear | Unclear | Unclear | Unclear |
Cough problem | 919 (3) | Considerable | Increase | Unclear | Increase | Unclear |
Speech problem | 919 (3) | Moderate | Increase | Small | Increase | 12 months |