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Christodoulidis G, Kouliou MN, Koumarelas KE, Giakoustidis D, Athanasiou T. Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies. Life (Basel) 2023; 13:1910. [PMID: 37763313 PMCID: PMC10532582 DOI: 10.3390/life13091910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Upper gastrointestinal (GI) conditions vastly affect each individual's physical, social, and emotional status. The decision-making process by the medical personnel about these patients is currently based on a patient's life quality evaluation scale, HRQL scales. By utilizing HRQL scales, a better understanding of the various surgical and non-surgical treatment options, as well as their long-term consequences, can be achieved. In our study, an organ-based approach is used in an attempt to examine and characterized the effect of upper GI surgery on HRQL. Therefore, HRQL scales' function as a prognostic tool is useful, and the need for future research, the creation of valid training programs, and modern guidelines is highlighted.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Marina-Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Konstantinos-Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Dimitris Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece;
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H Ringborg C, Cheng Z, Johar A, Schandl A, Lagergren P. Associations in health-related quality of life between patients and family caregivers 1 year after oesophageal cancer surgery. Eur J Oncol Nurs 2023; 62:102235. [PMID: 36410265 DOI: 10.1016/j.ejon.2022.102235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Whether patients' health-related quality of life (HRQL) influences the HRQL of their family caregivers remains to be clarified. Therefore, the aim of this study was to investigate the association in HRQL between patients and family caregivers one year after oesophageal cancer surgery. METHODS The study was based on a prospective, nationwide, and population-based cohort including patients treated by surgery for oesophageal cancer in Sweden from 2013 to 2021 and their family caregivers. Data were collected one year after surgery, using the summary score of the EORTC QLQ-C30 and the RAND-36 questionnaire. Univariate and multivariate linear regression models providing regression coefficients with confidence intervals (CI) were used to estimate the association between the HRQL among patients and family caregivers. The analyses were adjusted for potential covariates. RESULTS In total, 275 patients and paired family caregivers were included in the study. Patients reported a mean HRQL summary score of 81.4, indicating reductions in functions as well as many burdensome symptoms. Among family caregivers, lowest HRQL scores were reported for pain (69.2 ± 26.0) and energy/fatigue (65.1 ± 20.4). A 10-point change in the patients' summary score corresponded to a 7-point change for family caregivers' emotional role function (β = 7.0; 95% CI: 3.6-10.3). For other HRQL dimensions among the family caregivers, no clinically relevant associations with patients HRQL were found. CONCLUSION The current study indicates that family caregivers' emotional role function is influenced by patients' overall HRQL one year after surgery. The finding suggests that follow-up interventions should include not only patients but also their family caregivers.
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Affiliation(s)
- Cecilia H Ringborg
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Zhao Cheng
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Anna Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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3
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Bograd AJ, Molena D. Minimally invasive esophagectomy. Curr Probl Surg 2021; 58:100984. [PMID: 34629156 DOI: 10.1016/j.cpsurg.2021.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Daniela Molena
- Weill Cornell Medical College, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY.
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Does it matter how we evaluate HRQOL? Longitudinal comparison of the EORTC QLQ-C30/QLQ-OG25 and FACT-E. J Cancer Surviv 2020; 15:641-650. [PMID: 33106994 DOI: 10.1007/s11764-020-00957-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether EORTC QLQ-C30/QLQ-OG25 and FACT-E compared longitudinally provide similar reflections of health-related quality of life (HRQOL). METHODS Eighty-six esophageal cancer patients treated with curative intent, scheduled to complete both questionnaires at baseline and post-treatment time points until 36 months. A generalized estimating equation model utilizing a Gaussian family compared instruments longitudinally. The two-one-sided-test (TOST) method assessed equivalence between the instruments. RESULTS Trajectories for social domain and overall quality of life differed significantly between instruments. Also, FACT-G's functional well-being post-treatment returns to baseline 3-6 months earlier than the EORTC QLQ-C30's role functioning subscale, suggesting measurement of different components. Trajectories for physical and esophageal symptom subscales are similar and are deemed equivalent. Emotional domains are comparable and bear little resemblance to the physical domain trajectories indicating reflection of emotional experience rather than a physical proxy. EORTC QLQ-C30 subscales have a trajectory similar to its physical functioning scale except for the emotional and esophageal symptoms scales. Overall HRQOL in both instruments showed a consistent return to baseline/pre-treatment levels by 6 months post-treatment. CONCLUSIONS Overall HRQOL recovers earlier after curative-intent treatment than previously reported despite persistence of physical symptoms, with a consistent return to pre-treatment levels by 6 months after treatment. This supports the concept that HRQOL is not primarily defined by physical function. Based on this longitudinal comparison, FACT-E provides a more multidimensional assessment of HRQOL. IMPLICATIONS FOR CANCER SURVIVORS Curative intent treatment for esophageal cancer has adverse effects on HRQOL but despite intense treatment, overall HRQOL recovers within 6 months.
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van den Boorn HG, Stroes CI, Zwinderman AH, Eshuis WJ, Hulshof MCCM, van Etten-Jamaludin FS, Sprangers MAG, van Laarhoven HWM. Health-related quality of life in curatively-treated patients with esophageal or gastric cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 154:103069. [PMID: 32818901 DOI: 10.1016/j.critrevonc.2020.103069] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Surgery and chemoradiotherapy can potentially cure esophageal and gastric cancer patients, although they may impact health-related quality of life (HRQoL). We aim to systemically review and meta-analyze literature to determine the effect of curative treatments on HRQoL in esophageal and gastric cancer.- A systematic search was performed identifying studies assessing HRQoL. Meta-analyses were performed on baseline and subsequent time-points.- From the 6067 articles retrieved, 49 studies were included (61 % low quality). Meta-analyses showed short-term HRQoL differences between esophageal cancer patients receiving definitive chemoradiotherapy (dCRT), neoadjuvant chemo(radio)therapy (nC(R)T), or surgery alone (p < 0.001), with better HRQoL with nC(R)T and surgery compared to dCRT. Over the course of 12 months, no HRQoL difference was identified between treatments in esophageal cancer (p = 0.633). Esophagectomy, but not gastrectomy, resulted in a clinically relevant decline in HRQoL. No long-term HRQoL differences were identified between curative treatments in esophageal and gastric cancer. More high-quality HRQoL studies are warranted.
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Affiliation(s)
- Héctor G van den Boorn
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charlotte I Stroes
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam UMC, University of Amsterdam, Department of Radiotherapy, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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6
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Hauge T, Amdal CD, Falk RS, Johannessen HO, Johnson E. Long-term outcome in patients operated with hybrid esophagectomy for esophageal cancer - a cohort study. Acta Oncol 2020; 59:859-865. [PMID: 32324079 DOI: 10.1080/0284186x.2020.1750694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Over the past two decades, hybrid and total minimally invasive esophagectomy for esophageal cancer (EC) has increasingly been implemented with the aim to improve morbidity, functional result and ultimately the prognosis in these patients. However, more results are warranted and in this single-center study we report long-time outcome in a cohort of cancer patients treated with hybrid esophagectomy (HE).Material and methods: Hundred and nine patients with EC operated with HE from November 2007 to June 2013 were included. Clinical, pathological and survival data were retrieved from the patient administration system and the Norwegian Cause of Death Registry. Patients alive were asked to fill out the Ogilvie dysphagia score, EORTC QLQ-C30 and EORTC QLQ-OG25. Survival was analyzed by Kaplan-Meier's method and prognostic factors by uni- and multivariable Cox regression analyses.Results: Median overall follow-up time was 55 months (range 2-135) after R0-2 resection (n = 109) and 76 months (5-135) for R0 resection (n = 100). Five-year overall survival rate was 49% and 53%, respectively. Anastomotic leakage rate and 90-days mortality were 5% and 2%, respectively. Six patients (6%) had later surgery for metastases to mediastinum, hepatoduodenal ligament, brain, lung, liver or bladder median 26 months (4-51) after HE. Forty-one out of 51 patients alive (80%) filled out questionnaires after median 65.5 months (63-123) follow-up. All patients could eat normal food without (n = 37) or with (n = 4) problems. Nearly, half of the patients reported problems with reflux, one-third experienced fatigue and anxiety while one out of four had weight loss and episodes of dyspnea.Conclusions: In this patient series, HE offered low postoperative mortality and good overall long-term survival. Most survivors maintained good quality of life more than five years post treatment. There was a low rate of serious postoperative complications.
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Affiliation(s)
- Tobias Hauge
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Cecilie Delphin Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Hans-Olaf Johannessen
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Egil Johnson
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Brierley RC, Gaunt D, Metcalfe C, Blazeby JM, Blencowe NS, Jepson M, Berrisford RG, Avery KNL, Hollingworth W, Rice CT, Moure-Fernandez A, Wong N, Nicklin J, Skilton A, Boddy A, Byrne JP, Underwood T, Vohra R, Catton JA, Pursnani K, Melhado R, Alkhaffaf B, Krysztopik R, Lamb P, Culliford L, Rogers C, Howes B, Chalmers K, Cousins S, Elliott J, Donovan J, Heys R, Wickens RA, Wilkerson P, Hollowood A, Streets C, Titcomb D, Humphreys ML, Wheatley T, Sanders G, Ariyarathenam A, Kelly J, Noble F, Couper G, Skipworth RJE, Deans C, Ubhi S, Williams R, Bowrey D, Exon D, Turner P, Daya Shetty V, Chaparala R, Akhtar K, Farooq N, Parsons SL, Welch NT, Houlihan RJ, Smith J, Schranz R, Rea N, Cooke J, Williams A, Hindmarsh C, Maitland S, Howie L, Barham CP. Laparoscopically assisted versus open oesophagectomy for patients with oesophageal cancer-the Randomised Oesophagectomy: Minimally Invasive or Open (ROMIO) study: protocol for a randomised controlled trial (RCT). BMJ Open 2019; 9:e030907. [PMID: 31748296 PMCID: PMC6887040 DOI: 10.1136/bmjopen-2019-030907] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/17/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Surgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK. This can be performed as an open oesophagectomy (OO), a laparoscopically assisted oesophagectomy (LAO) or a totally minimally invasive oesophagectomy (TMIO). All three are performed in the National Health Service, with LAO and OO the most common. However, there is limited evidence about which surgical approach is best for patients in terms of survival and postoperative health-related quality of life. METHODS AND ANALYSIS We will undertake a UK multicentre randomised controlled trial to compare LAO with OO in adult patients with oesophageal cancer. The primary outcome is patient-reported physical function at 3 and 6 weeks postoperatively and 3 months after randomisation. Secondary outcomes include: postoperative complications, survival, disease recurrence, other measures of quality of life, spirometry, success of patient blinding and quality assurance measures. A cost-effectiveness analysis will be performed comparing LAO with OO. We will embed a randomised substudy to evaluate the safety and evolution of the TMIO procedure and a qualitative recruitment intervention to optimise patient recruitment. We will analyse the primary outcome using a multi-level regression model. Patients will be monitored for up to 3 years after their surgery. ETHICS AND DISSEMINATION This study received ethical approval from the South-West Franchay Research Ethics Committee. We will submit the results for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN10386621.
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Affiliation(s)
- Rachel C Brierley
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Marcus Jepson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Kerry N L Avery
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Caoimhe T Rice
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Aida Moure-Fernandez
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Newton Wong
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Joanna Nicklin
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anni Skilton
- Medical Illustration, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Alex Boddy
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | - James P Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Tim Underwood
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Ravi Vohra
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - James A Catton
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - Kish Pursnani
- Department of Upper GI Surgery, Royal Preston Hospital, Preston, UK
| | - Rachel Melhado
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Richard Krysztopik
- Gastroenterology Department, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Peter Lamb
- General Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lucy Culliford
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, University of Bristol, Bristol, UK
| | - Chris Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, University of Bristol, Bristol, UK
| | - Benjamin Howes
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katy Chalmers
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sian Cousins
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachael Heys
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, University of Bristol, Bristol, UK
| | - Robin A Wickens
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, University of Bristol, Bristol, UK
| | - Paul Wilkerson
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Hollowood
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christopher Streets
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dan Titcomb
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Tim Wheatley
- Upper GI Surgery, Derriford Hospital, Plymouth, UK
| | | | | | - Jamie Kelly
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Fergus Noble
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Graeme Couper
- General Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Chris Deans
- General Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sukhbir Ubhi
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | - Robert Williams
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | - David Bowrey
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | - David Exon
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | - Paul Turner
- Department of Upper GI Surgery, Royal Preston Hospital, Preston, UK
| | | | - Ram Chaparala
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Khurshid Akhtar
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Naheed Farooq
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Simon L Parsons
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - Neil T Welch
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - Rebecca J Houlihan
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Joanne Smith
- Upper GI Surgery, Derriford Hospital, Plymouth, UK
| | - Rachel Schranz
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Nicola Rea
- General Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jill Cooke
- Department of Surgery, Leicester Royal Infirmary, Leicester, Leicester, UK
| | | | - Carolyn Hindmarsh
- Department of Oesophago-Gastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Sally Maitland
- Department of General Surgery, Nottingham City Hospital, Nottingham, UK
| | - Lucy Howie
- Gastroenterology Department, Royal United Hospital Bath NHS Trust, Bath, UK
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Sugawara K, Yoshimura S, Yagi K, Nishida M, Aikou S, Yamagata Y, Mori K, Yamashita H, Seto Y. Long-term health-related quality of life following robot-assisted radical transmediastinal esophagectomy. Surg Endosc 2019; 34:1602-1611. [DOI: 10.1007/s00464-019-06923-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/12/2019] [Indexed: 02/08/2023]
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Sarkaria IS, Rizk NP, Goldman DA, Sima C, Tan KS, Bains MS, Adusumilli PS, Molena D, Bott M, Atkinson T, Jones DR, Rusch VW. Early Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy. Ann Thorac Surg 2019; 108:920-928. [PMID: 31026433 DOI: 10.1016/j.athoracsur.2018.11.075] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/25/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy may improve some perioperative outcomes over open approaches; effects on quality of life are less clear. METHODS A prospective trial of robotic-assisted minimally invasive esophagectomy (RAMIE) and open esophagectomy was initiated, measuring quality of life via the Functional Assessment of Cancer Therapy-Esophageal and Brief Pain Inventory. Mixed generalized linear models assessed associations between quality of life scores over time and by surgery type. RESULTS In total, 106 patients underwent open esophagectomy; 64 underwent minimally invasive esophagectomy (98% RAMIE). The groups did not differ in age, sex, comorbidities, histologic subtype, stage, or induction treatment (P = .42 to P > .95). Total Functional Assessment of Cancer Therapy-Esophageal scores were lower at 1 month (P < .001), returned to near baseline by 4 months, and did not differ between groups (P = .83). Brief Pain Inventory average pain severity (P = .007) and interference (P = .004) were lower for RAMIE. RAMIE had lower estimated blood loss (250 vs 350 cm3; P < .001), shorter length of stay (9 vs 11 days; P < .001), fewer intensive care unit admissions (8% vs 20%; P = .033), more lymph nodes harvested (25 vs 22; P = .05), and longer surgical time (6.4 vs 5.4 hours; P < .001). Major complications (39% for RAMIE vs 52% for open esophagectomy; P > .95), anastomotic leak (3% vs 9%; P = .41), and 90-day mortality (2% vs 4%; P = .85) did not differ between groups. Pulmonary (14% vs 34%; P = .014) and infectious (17% vs 36%; P = .029) complications were lower for RAMIE. CONCLUSIONS RAMIE is associated with lower immediate postoperative pain severity and interference and decreased pulmonary and infectious complications. Ongoing data accrual will assess mid-term and long-term outcomes in this cohort.
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Affiliation(s)
- Inderpal S Sarkaria
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Nabil P Rizk
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Camelia Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S Bains
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Bott
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Atkinson
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Ericson J, Lundell L, Klevebro F, Kamiya S, Nilsson M, Rouvelas I. Long-term weight development after esophagectomy for cancer-comparison between open Ivor-Lewis and minimally invasive surgical approaches. Dis Esophagus 2019; 32:5142515. [PMID: 30351390 DOI: 10.1093/dote/doy075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophagectomy is an extensive procedure with severe postoperative effects. It can be assumed that the greater the trauma, the longer the nutritional recovery. This retrospective observational single-center cohort study compared weight development after esophagectomy with open and minimally invasive techniques. Three groups were compared in this study, one representing the first 41 patients who underwent the minimally invasive McKeown esophagectomy (MIMK). The second group included the first 84 consecutive patients operated with the minimally invasive Ivor-Lewis esophagectomy (MIIL). The third group comprised 100 consecutive patients operated with open thoracoabdominal Ivor-Lewis esophagectomy (IL). Virtually all patients submitted to a minimally invasive esophagectomy (MIE) and the majority with an IL had a jejunal catheter inserted during operation for postoperative enteral feeding. All together 225 patients were included in this study. The mean weight loss during the first year was 13.1% (±4.1), 11.2% (±6.1), and 9.6% (±7.5) in the IL, MIIL, and MIMK group, respectively (P = 0.85 and P = 0.95, respectively). The median duration of postoperative enteral nutrition support varied substantially within the groups and was 23.5 days in the IL group (range: 0-2033 days), 54.5 days in those having an MIIL (range: 0-308 days; P ≤ 0.001) and 57.0 days among patients in the MIMK group (range: 0-538 days; P ≤ 0.022). There was no difference in the risk of losing at least 10% of the preoperative weight at 3 or 6 months postoperatively between the groups. However, in patients who suffered severe complications (Clavien-Dindo score ≥ IIIb) after MIIL, there was a nonsignificant trend toward a lower risk of a 10% or greater weight loss, 3 months postoperatively. In conclusion, the greater surgical trauma associated with the traditional open esophagectomy was not followed by more severe weight loss, or other signs of poorer nutritional recovery, when compared to minimal invasive surgical techniques.
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Affiliation(s)
- J Ericson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Function area Clinical Nutrition
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Klevebro
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - S Kamiya
- Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Rouvelas
- Division of Surgery, Department of Clinical Science, Technology and Intervention (CLINTEC), Karolinska Institutet.,Department of Surgery, Centre of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
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11
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van den Berg JW, Luketich JD, Cheong E. Oesophagectomy: The expanding role of minimally invasive surgery in oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:75-80. [PMID: 30551859 DOI: 10.1016/j.bpg.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
Historically, open oesophagectomy was the gold standard for oesophageal cancer surgery. This was associated with a relatively higher morbidity. In the last two decades, we have seen significant improvements in short and long term outcomes due to centralisation of oesophagectomy, multidisciplinary approach, enhanced recovery after surgery programmes, neoadjuvant treatments and advances in minimally invasive oesophagectomy (MIO) techniques. MIO has significantly reduced postoperative morbidity and improved functional recovery, while maintaining comparable long-term oncological outcomes. MIO is technically demanding, and requires a long learning curve. However, it has been proven to be safe and successful in expert centres. This is a review on the current role of MIO in the management of oesophageal cancer.
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Affiliation(s)
- J W van den Berg
- Department of Upper GI Surgery and General Surgery, Norfolk and Norwich University Hospital, Colney Lane, NR4 7UY, Norwich, United Kingdom.
| | - J D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, 15213, PA, Pennsylvania, United States.
| | - E Cheong
- Department of Upper GI Surgery and General Surgery, Norfolk and Norwich University Hospital, Colney Lane, NR4 7UY, Norwich, United Kingdom.
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12
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Asti E, Bernardi D, Sozzi M, Bonavina L. Minimally invasive esophagectomy for Barrett's adenocarcinoma. Transl Gastroenterol Hepatol 2018; 3:77. [PMID: 30505964 DOI: 10.21037/tgh.2018.09.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/28/2018] [Indexed: 12/15/2022] Open
Abstract
Minimally invasive esophagectomy has become the preferred approach for invasive Barrett's adenocarcinoma because it can speed recovery and enhance patient's quality of life. Multiple minimally invasive surgical techniques have been described during the last two decades. Preoperative staging, anatomy and physiological patient's status, comorbidity, and experience of the surgical team should drive the choice of the surgical approach. The trans-thoracic Ivor Lewis esophagectomy, either hybrid or totally minimal invasive, remains the preferred approach in these patients. Lymph node yield and short-term clinical outcomes have proven similar to open surgery, while quality of life appears improved. To establish a minimally invasive esophagectomy program, a steep learning curve and a multidisciplinary approach are required in order to provide optimal staging, personalized therapy, and adequate perioperative care. The role of minimally invasive surgery in the treatment of invasive Barrett's adenocarcinoma will continue to expand in synergy with enhanced recovery after surgery pathways.
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Affiliation(s)
- Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Italy
| | - Daniele Bernardi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Italy
| | - Marco Sozzi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Italy
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13
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Zhang Y, Yang X, Geng D, Duan Y, Fu J. The change of health-related quality of life after minimally invasive esophagectomy for esophageal cancer: a meta-analysis. World J Surg Oncol 2018; 16:97. [PMID: 29793487 PMCID: PMC5968615 DOI: 10.1186/s12957-018-1330-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/04/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Short- and long-term health-related quality of life (HRQL) was severely affected after surgery. This study aimed to assess the direction and duration of HRQL from 3- to 24-month follow-ups after minimally invasive esophagectomy (MIE) for esophageal cancer. METHODS A systematic literature search in MEDLINE, EMBASE, and the Cochrane database was performed for all potentially relevant studies published until February 2017. Studies were included if they addressed the question of HRQL with OERTC-QLQ-C30 and OES18. Primary outcomes were HRQL change at 3-month follow-up. Secondary outcomes were HRQL change from 3-, 6- (short-term) to 12- (mid-term), and/or 24-month (long-term) follow-ups. RESULTS Six articles were included to estimate the change in 24 HRQL outcomes after MIE. Most of the patients' HRQL outcomes deteriorated at short-term follow-up and some lasted to mid- or long-term after MIE. Patients' physical function and global QOL deteriorated from short- to long-term follow-ups, and emotional function had no change. The directions of dyspnea, pain, fatigue, insomnia, constipation, diarrhea, cough, and speech problems were increased. The deterioration in global function lasted 6 months, the increase in constipation and speech problems lasted 12 months, and insomnia increased more than 12 months after MIE. CONCLUSIONS The emotional function had no change after MIE. The global QOL become worse during early postoperative period; the symptoms of constipation, speech problems, and insomnia increased for a long time after MIE.
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Affiliation(s)
- Yong Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Xiaomei Yang
- Hospital 521 of China’s Ordnance Industry Group, Xi’an, 710065 China
| | - Donghong Geng
- School of Continuing Education of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Yingfei Duan
- Department of Pathology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
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14
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Metcalfe C, Avery K, Berrisford R, Barham P, Noble SM, Fernandez AM, Hanna G, Goldin R, Elliott J, Wheatley T, Sanders G, Hollowood A, Falk S, Titcomb D, Streets C, Donovan JL, Blazeby JM. Comparing open and minimally invasive surgical procedures for oesophagectomy in the treatment of cancer: the ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) feasibility study and pilot trial. Health Technol Assess 2018; 20:1-68. [PMID: 27373720 DOI: 10.3310/hta20480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Localised oesophageal cancer can be curatively treated with surgery (oesophagectomy) but the procedure is complex with a risk of complications, negative effects on quality of life and a recovery period of 6-9 months. Minimal-access surgery may accelerate recovery. OBJECTIVES The ROMIO (Randomised Oesophagectomy: Minimally Invasive or Open) study aimed to establish the feasibility of, and methodology for, a definitive trial comparing minimally invasive and open surgery for oesophagectomy. Objectives were to quantify the number of eligible patients in a pilot trial; develop surgical manuals as the basis for quality assurance; standardise pathological processing; establish a method to blind patients to their allocation in the first week post surgery; identify measures of postsurgical outcome of importance to patients and clinicians; and establish the main cost differences between the surgical approaches. DESIGN Pilot parallel three-arm randomised controlled trial nested within feasibility work. SETTING Two UK NHS departments of upper gastrointestinal surgery. PARTICIPANTS Patients aged ≥ 18 years with histopathological evidence of oesophageal or oesophagogastric junctional adenocarcinoma, squamous cell cancer or high-grade dysplasia, referred for oesophagectomy or oesophagectomy following neoadjuvant chemo(radio)therapy. INTERVENTIONS Oesophagectomy, with patients randomised to open surgery, a hybrid open chest and minimally invasive abdomen or totally minimally invasive access. MAIN OUTCOME MEASURE The primary outcome measure for the pilot trial was the number of patients recruited per month, with the main trial considered feasible if at least 2.5 patients per month were recruited. RESULTS During 21 months of recruitment, 263 patients were assessed for eligibility; of these, 135 (51%) were found to be eligible and 104 (77%) agreed to participate, an average of five patients per month. In total, 41 patients were allocated to open surgery, 43 to the hybrid procedure and 20 to totally minimally invasive surgery. Recruitment is continuing, allowing a seamless transition into the definitive trial. Consequently, the database is unlocked at the time of writing and data presented here are for patients recruited by 31 August 2014. Random allocation achieved a good balance between the arms of the study, which, as a high proportion of patients underwent their allocated surgery (69/79, 87%), ensured a fair comparison between the interventions. Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind while pain was assessed during the first week post surgery. Postsurgical length of stay and risk of adverse events were within the typical range for this group of patients, with one death occurring within 30 days among 76 patients. There were good completion rates for the assessment of pain at 6 days post surgery (88%) and of the patient-reported outcomes at 6 weeks post randomisation (74%). CONCLUSIONS Rapid recruitment to the pilot trial and the successful refinement of methodology indicated the feasibility of a definitive trial comparing different approaches to oesophagectomy. Although we have shown a full trial of open compared with minimally invasive oesophagectomy to be feasible, this is necessarily based on our findings from the two clinical centres that we could include in this small preliminary study. TRIAL REGISTRATION Current Controlled Trials ISRCTN59036820. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Chris Metcalfe
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kerry Avery
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard Berrisford
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Paul Barham
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sian M Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - George Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Robert Goldin
- Department of Cellular Pathology, Imperial College London, London, UK
| | - Jackie Elliott
- Gastro-Oesophageal Support and Help Group, Kingswood, Bristol, UK
| | - Timothy Wheatley
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Grant Sanders
- Department of Upper Gastrointestinal Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Andrew Hollowood
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stephen Falk
- Bristol Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Dan Titcomb
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christopher Streets
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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15
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Alghamedi A, Buduhan G, Tan L, Srinathan SK, Sulman J, Darling G, Kidane B. Quality of life assessment in esophagectomy patients. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:84. [PMID: 29666807 DOI: 10.21037/atm.2017.11.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Esophagectomy is the mainstay of curative therapy for esophageal cancer; however, it is associated with significant morbidity and mortality, with subsequent major impact on quality of life. This paper reviews the evaluation of health-related quality of life (HRQOL) in esophageal cancer patients undergoing curative intent therapy, the relationship between postoperative HRQOL and survival as well the potential utility of pre-treatment HRQOL as a prognostic tool. HRQOL assessment is valuable in helping clinicians understand the impact on patients of esophageal cancer and the various treatments thereof. HRQOL is also valuable as an end-point in studies of esophageal cancer and esophageal cancer treatment. Given the morbidity and mortality associated with the various treatments for esophageal cancer, it could be argued that HRQOL is as important an endpoint as survival, if not more so. Patient-reported pre-treatment HRQOL assessment appears to predict survival better than clinician-derived performance status assessment period. HRQOL assessment also appears to be responsive to surgical and non-surgical therapy and thus could potentially be used in trials and in practice to serve that function. Thus, HRQOL assessment could be a potentially important adjunct in shared decision-making and guiding treatment planning as well as monitoring the progress of treatment.
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Affiliation(s)
- Alla Alghamedi
- Section of General Surgery, University of Manitoba, Winnipeg, Canada.,Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | | | - Joanne Sulman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Gail Darling
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
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16
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Soriano TT, Eslick GD, Vanniasinkam T. Long-Term Nutritional Outcome and Health Related Quality of Life of Patients Following Esophageal Cancer Surgery: A Meta-Analysis. Nutr Cancer 2017; 70:192-203. [PMID: 29281327 DOI: 10.1080/01635581.2018.1412471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Long term health related quality of life (HRQL) and nutritional outcome of patients following esophagectomy for cancer has become increasingly significant as the 5-year survival rate in this patient group is increasing. This meta-analysis aims to investigate the HRQOL, nutritional impact symptoms and nutritional outcomes of patients following an esophagectomy at greater than 12 months after surgery. In studies reporting on HRQL as an outcome, global QOL score at 6-month compare to greater than 12-month showed no statistically significant difference (65.92 vs. 75.78, p = 0.07). Forty-one percent of patients reported a greater than 10% weight loss at six-month follow-up (95% CI: 20-65%; I2 = 94.27, p < 0.001), and at the greater than 12-month follow-up, 33% of patients had the greater than 10% weight loss (95% CI: 15-57%; I2 = 96.18, p < 0.001). At the 12-month or longer post esophagectomy, just over half the patients reported dysphagia (51%, 95% CI: 25-76%; I2 = 95.70, p < 0.001), nausea was reported by 11% (95% CI: 7-19%; I2 = 59.31, p = 0.09), dumping syndrome reported by 60% (95% CI: 43-76%; I2 = 96.92, p < 0.001). Symptoms such as dysphagia, diarrhea, reflux, dumping syndrome, and nausea were found to persist following esophagectomy. There were insufficient robust research investigating how these symptoms impact on the adequacy of dietary intake and micronutrient status.
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Affiliation(s)
- Trang Thuy Soriano
- a Department of Nutrition and Dietetics , Nepean Blue Mountains Local Health District, Nepean Hospital , Penrith , New South Wales , Australia
| | - Guy D Eslick
- b Department of Surgery , Nepean Hospital, Clinical School Building , Penrith , New South Wales , Australia
| | - Thiru Vanniasinkam
- c School of Biomedical Sciences , Charles Sturt University , Wagga Wagga , New South Wales , Australia
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17
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Kauppila JH, Helminen O, Kytö V, Gunn J, Lagergren J, Sihvo E. Short-Term Outcomes Following Minimally Invasive and Open Esophagectomy: A Population-Based Study from Finland and Sweden. Ann Surg Oncol 2017; 25:326-332. [PMID: 29094248 DOI: 10.1245/s10434-017-6212-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based studies comparing minimally invasive esophagectomy (MIE) and open esophagectomy (OE) relative to 90-day postoperative mortality are needed. OBJECTIVE The aim of this study was to compare short-term outcomes following these two techniques for esophageal cancer. METHODS Patients undergoing MIE (n = 217) or OE (n = 1397) for esophageal cancer between 2007 and 2014 were identified from nationwide complete registries in Finland and Sweden. The primary outcome was 90-day mortality, and secondary outcomes were 30-day mortality, length of hospital stay, and 30- and 90-day readmission rate. Results were adjusted for age, sex, comorbidity, tumor histology, surgery year, and country. RESULTS Ninety-day mortality rates were 4.1% (n = 9 of 217) for MIE and 6.8% (n = 95 of 1397) for OE; 90-day mortality was halved after MIE [adjusted hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.24-0.99]. There was no difference in 30-day mortality (adjusted HR 0.87, 95% CI 0.29-2.66). Median hospital stay was 15 days for MIE and 16 days for OE (adjusted β -0.17, standard error 0.08, p = 0.030). The 30-day readmission rates were 8.9% after MIE and 12.0% after OE (adjusted HR 0.57, 95% CI 0.34-0.94), while the 90-day readmission rates were 28.8% and 33.6%, respectively, without a statistically significant difference (adjusted HR 0.82, 95% CI 0.61-1.10). CONCLUSIONS This population-based study from Finland and Sweden revealed lower 90-day mortality, shorter hospital stay, and lower 30-day readmission rates after MIE compared with OE for esophageal cancer. These findings support the use of minimally invasive approaches.
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Affiliation(s)
- Joonas H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden.,Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olli Helminen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Surgery, Central Finland Central Hospital, 40620, Jyväskylä, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Surgery, Faculty of Medicine, University of Turku, Turku, Finland
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden.,Division of Cancer Studies, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, 40620, Jyväskylä, Finland.
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18
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Taioli E, Schwartz RM, Lieberman-Cribbin W, Moskowitz G, van Gerwen M, Flores R. Quality of Life after Open or Minimally Invasive Esophagectomy in Patients With Esophageal Cancer-A Systematic Review. Semin Thorac Cardiovasc Surg 2017; 29:377-390. [PMID: 28939239 DOI: 10.1053/j.semtcvs.2017.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 02/08/2023]
Abstract
Although esophageal cancer is rare in the United States, 5-year survival and quality of life (QoL) are poor following esophageal cancer surgery. Although esophageal cancer has been surgically treated with esophagectomy through thoracotomy, an open procedure, minimally invasive surgical procedures have been recently introduced to decrease the risk of complications and improve QoL after surgery. The current study is a systematic review of the published literature to assess differences in QoL after traditional (open) or minimally invasive esophagectomy. We hypothesized that QoL is consistently better in patients treated with minimally invasive surgery than in those treated with a more traditional and invasive approach. Although global health, social function, and emotional function improved more commonly after minimally invasive surgery compared with open surgery, physical function and role function, as well as symptoms including choking, dysphagia, eating problems, and trouble swallowing saliva, declined for both surgery types. Cognitive function was equivocal across both groups. The potential small benefits in global and mental health status among those who experience minimally invasive surgery should be considered with caution given the possibility of publication and selection bias.
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Affiliation(s)
- Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health Hofstra Northwell School of Medicine, Great Neck, New York
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gil Moskowitz
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maaike van Gerwen
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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19
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Bonavina L, Asti E, Sironi A, Bernardi D, Aiolfi A. Hybrid and total minimally invasive esophagectomy: how I do it. J Thorac Dis 2017; 9:S761-S772. [PMID: 28815072 DOI: 10.21037/jtd.2017.06.55] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Esophagectomy is a major surgical procedure associated with a significant risk of morbidity and mortality. Minimally invasive esophagectomy is becoming the preferred approach because of the potential to limit surgical trauma, reduce respiratory complications, and promote earlier functional recovery. Various hybrid and total minimally invasive surgical techniques have been introduced in clinical practice over the past 20 years, and minimally invasive esophagectomy has been shown equivalent to open surgery concerning the short-term outcomes. Implementation of a minimally invasive esophagectomy program is technically demanding and requires a significant learning curve and the infrastructure of a dedicated multidisciplinary center where optimal staging, individualized therapy, and perioperative care can be provided to the patient. Both hybrid and total minimally invasive techniques of esophagectomy have proven safe and effective in expert centers. The choice of the surgical approach should be driven by preoperative staging, tumor site and histology, comorbidity, patient's anatomy and physiological status, and surgeon's experience.
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Affiliation(s)
- Luigi Bonavina
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Sironi
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Daniele Bernardi
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
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20
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21
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Straatman J, Joosten PJM, Terwee CB, Cuesta MA, Jansma EP, van der Peet DL. Systematic review of patient-reported outcome measures in the surgical treatment of patients with esophageal cancer. Dis Esophagus 2016; 29:760-772. [PMID: 26471471 DOI: 10.1111/dote.12405] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer is currently the eighth most common cancer worldwide. Improvements in operative techniques and neoadjuvant therapies have led to improved outcomes. Resection of the esophagus carries a high risk of severe complications and has a negative impact on health-related quality of life (QOL). The aim of this study was to assess which patient-reported outcome measures (PROMs) are used to measure QOL after esophagectomy for cancer. A comprehensive search of original articles was conducted investigating QOL after surgery for esophageal carcinoma. Two authors independently selected relevant articles, conducted clinical appraisal, and extracted data (PJ and JS). Out of 5893 articles, 58 studies were included, consisting of 41 prospective and 17 retrospective cohort studies, including a total of 6964 patients. These studies included 11 different PROMs. The existing PROMs could be divided into generic, symptom-specific, and disease-specific questionnaires. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ C-30) along with the EORTC QLQ-OESophagus module OES18 was the most widely used; in 42 and 32 studies, respectively. The EORTC and the Functional Assessment of Cancer Therapy (FACT) questionnaires use an oncological module and an organ-specific module. One validation study was available, which compared the FACT and EORTC, showing moderate to poor correlation between the questionnaires. A great variety of PROMs are being used in the measurement of QOL after surgery for esophageal cancer. A questionnaire with a general module along with a disease-specific module for assessment of QOL of different treatment modalities seem to be the most desirable, such as the EORTC and the FACT with their specific modules (EORTC QLQ-OES18 and FACT-E). Both are developed in different treatment modalities, such as in surgical patients. With regard to reproducibility of current results, the EORTC is recommended.
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Affiliation(s)
- J Straatman
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - P J M Joosten
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - C B Terwee
- Departments of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Cuesta
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - E P Jansma
- Medical library, VU University Medical Center, Amsterdam, The Netherlands
| | - D L van der Peet
- Departments of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, The Netherlands
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22
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Trudel JG, Sulman J, Atenafu EG, Kidane B, Darling GE. Longitudinal Evaluation of Trial Outcome Index Scores in Patients With Esophageal Cancer. Ann Thorac Surg 2016; 102:269-75. [DOI: 10.1016/j.athoracsur.2016.01.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 10/21/2022]
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23
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A Propensity-matched Analysis Comparing Survival After Esophagectomy Followed by Adjuvant Chemoradiation to Surgery Alone for Esophageal Squamous Cell Carcinoma. Ann Surg 2016; 264:100-6. [DOI: 10.1097/sla.0000000000001410] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Quality of Life and Late Complications After Minimally Invasive Compared to Open Esophagectomy: Results of a Randomized Trial. World J Surg 2016; 39:1986-93. [PMID: 26037024 PMCID: PMC4496501 DOI: 10.1007/s00268-015-3100-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The minimally invasive esophagectomy (MIE) is widely being implemented for esophageal cancer in order to reduce morbidity and improve quality of life. Non-randomized studies investigating the mid-term quality of life after MIE show conflicting results at 1-year follow-up. Therefore, the aim of this study is to determine whether MIE has a continuing better mid-term 1-year quality of life than open esophagectomy (OE) indicating both a faster recovery and less procedure-related symptoms. Methods A one-year follow-up analysis of the quality of life was conducted for patients participating in the randomized trial in which MIE was compared with OE. Late complications as symptomatic stenosis of anastomosis are also reported. Results Quality of life at 1 year was better in the MIE group than in the OE group for the physical component summary SF36 [50 (6; 48–53) versus 45 (9; 42–48) p .003]; global health C30 [79 (10; 76–83) versus 67 (21; 60–75) p .004]; and pain OES18 module [6 (9; 2–8) versus 16 (16; 10–22) p .001], respectively. Twenty six patients (44 %) in the MIE and 22 patients (39 %) in the OE group were diagnosed and treated for symptomatic stenosis of the anastomosis. Conclusions This first randomized trial shows that MIE is associated with a better mid-term one-year quality of life compared to OE.
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Blencowe NS, Strong S, McNair AGK, Howes N, Elliot J, Avery KN, Blazeby JM. Assessing the quality of written information provision for surgical procedures: a case study in oesophagectomy. BMJ Open 2015; 5:e008536. [PMID: 26459487 PMCID: PMC4606391 DOI: 10.1136/bmjopen-2015-008536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To examine the content and quality of written information provided by surgical centres for patients undergoing oesophagectomy for cancer. DESIGN Cross-sectional study of the content of National Health Service (NHS) patient information leaflets (PILs) about oesophageal cancer surgery, using a modified framework approach. DATA SOURCES Written information leaflets from 41 of 43 cancer centres undertaking surgery for oesophageal cancer in England and Wales (response rate 95.3%). ELIGIBILITY CRITERIA All English language versions of PILs about oesophagectomy. RESULTS 32 different PILs were identified, of which 2 were generic tools (Macmillan 'understanding cancer of the gullet' and EIDO 'oesophagectomy'). Although most PILs focused on describing in-hospital adverse events, information varied widely and was often misleading. Just 1 leaflet described survival benefits of surgery and 2 mentioned the possibility of disease recurrence. CONCLUSIONS Written information provided for patients by NHS cancer centres undertaking oesophagectomy is inconsistent and incomplete. It is recommended that surgeons work together with patients to agree on standards of information provision of relevance to all stakeholders' needs.
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Affiliation(s)
- N S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Strong
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N Howes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Elliot
- Gastro-Oesophageal Support and Help (GOSH) Group, Bristol, UK
| | - K N Avery
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Bonavina L, Scolari F, Aiolfi A, Bonitta G, Sironi A, Saino G, Asti E. Early outcome of thoracoscopic and hybrid esophagectomy: Propensity-matched comparative analysis. Surgery 2015; 159:1073-81. [PMID: 26422764 DOI: 10.1016/j.surg.2015.08.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/07/2015] [Accepted: 08/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transthoracic esophagectomy remains the current therapeutic standard for localized esophageal carcinoma. Minimally invasive surgery has proven at least equivalent to open surgery regarding the early outcomes, but only 1 randomized study has compared the thoracoscopic with the thoracotomy approach. The primary objective of this study was to assess the early outcome of the thoracoscopic prone esophagectomy (TPE) and the hybrid Ivor Lewis (HIL) esophagectomy in 2 concurrent patient cohorts. METHODS We compared the 1-year outcome of 3-stage TPE and 2-stage HIL done over the same time period in a single center. The propensity score matching method was used to reduce selection bias by creating 2 groups of patients similarly likely to receive a treatment on the basis of measured baseline characteristics. After generating propensity scores using the covariates of age, sex, body mass index, forced expiration volume at 1 second, Charlson comorbidity index, American Society of Anesthesiologists score, histologic tumor type, tumor site, pTNM stage, and neoadjuvant therapy, 93 TPE patients were matched with 197 HIL patients using a 1:1 ratio and the nearest-neighbor score matching. Main outcome measure was the incidence of postoperative complications. RESULTS Operative time was longer in TPE patients (P < .01). All postoperative outcomes, including morbidity, mortality, nodal harvest, R0 resection rate, and 1-year survival rates were similar in the 2 matched groups. CONCLUSION Both operative approaches are safe and effective; using 1 or the other depends on the tumor site, surgeon experience and preference, and patient expectations.
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Affiliation(s)
- Luigi Bonavina
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
| | - Federica Scolari
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrea Sironi
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Greta Saino
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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Rees J, Hurt CN, Gollins S, Mukherjee S, Maughan T, Falk SJ, Staffurth J, Ray R, Bashir N, Geh JI, Cunningham D, Roy R, Bridgewater J, Griffiths G, Nixon LS, Blazeby JM, Crosby T. Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer. Br J Cancer 2015; 113:603-10. [PMID: 26203761 PMCID: PMC4647690 DOI: 10.1038/bjc.2015.258] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/07/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here. METHODS Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented. RESULTS Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups. CONCLUSIONS CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.
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Affiliation(s)
- J Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C N Hurt
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, North Wales, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - S J Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Staffurth
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Ray
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - N Bashir
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Roy
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - G Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - L S Nixon
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
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28
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Wen Y, Pan XF, Huang WZ, Zhao ZM, Wei WQ, Chen F, Lan H, Huang H, Yang CX, Qiao YL. Quality of life for patients with esophageal/gastric cardia precursor lesions or cancer: a one-year prospective study. Asian Pac J Cancer Prev 2015; 16:45-51. [PMID: 25640389 DOI: 10.7314/apjcp.2015.16.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The current study examined health-related quality of life (QoL) for patients with esophageal/ gastric cardia precursor lesions or cancer before and after treatment to facilitate improved prevention and treatment. MATERIALS AND METHODS Patients with different stages of esophageal/gastric cardia lesions completed two QoL questionnaires, EORTC QLQ-C30 and supplemental QLQ-OES 18, before primary treatment, and at 1, 6 and 12 months after treatment. RESULTS Fifty-nine patients with precursor lesions, 57 with early stage cancer, and 43 with advanced cancer responded to our survey. Patients with precursor lesions or early stage cancer reported better QoL overall than those with advanced cancer before treatment (p<0.01). Global QoL scores before treatment and at 1 month after treatment were 71±9 versus 69±9 (p>0.01), 71±8 versus 61±11 (p<0.01), 67 ± 11 versus 62 ± 9 (p<0.01) for three stages of lesions. At 6 months after treatment, some QoL measures recovered gradually in precursor lesion and early cancer patients, while some continuously deteriorated in advanced cancer patients. At 12 months, all QoL scores were comparable to baseline for patients with precursor lesions (p>0.01), while global QoL, social, pain, and insomnia scores for early stage and advanced cancer were inferior to corresponding baseline levels (difference between means>5, p<0.01). At this time point, compared with patients with early stage cancer, those with advanced cancer showed worse QoL with all function and most symptom measures (p<0.01). CONCLUSIONS Patients with precursor lesions or early stage esophageal/gastric cardia cancer show better QoL than those with advanced cancer. This indicates that screening, early diagnosis and treatment may improve the QoL for esophageal/gastric cardia cancer patients. Target intervention and counseling should be given by health care providers during treatment and follow-up to facilitate QoL improvement.
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Affiliation(s)
- Ying Wen
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China E-mail :
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29
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Zapletal C, Heesen C, Origer J, Pauthner M, Pech O, Ell C, Lorenz D. Quality of life after surgical treatment of early Barrett's cancer: a prospective comparison of the Ivor-Lewis resection versus the modified Merendino resection. World J Surg 2015; 38:1444-52. [PMID: 24378548 DOI: 10.1007/s00268-013-2410-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The Merendino (MER) procedure has been evaluated as an alternative to transthoracic esophageal resection (TER) for early stage Barrett's carcinoma. Apart from reducing morbidity and mortality, improvements concerning postoperative health-related quality of life (HRQL) have been postulated. The aim of our study was to compare HRQL between these procedures. MATERIALS AND METHODS Between July 2000 and July 2007, 117 patients with early Barrett's carcinoma underwent surgery. Patients with tumor recurrence were excluded from the study. HRQL was assessed 1 and 2 years after surgery using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (EORTC-QLQ-C30) and the QLQ-OES18 module. Patients recently diagnosed with early Barrett's carcinoma served as controls. Symptoms that showed a difference of more than ten between the control and the study groups were considered clinically relevant and were tested for significant differences between the study groups using the Mann-Whitney U test (p < 0.05). RESULTS The response rates for the questionnaires ranged between 70 and 93 %. In the MER group, more items reflected a clinical relevant impairment of HRQL than in the TER group. Significant complaints in the MER group included nausea/vomiting, appetite loss, local pain, difficulties with social eating, and choking. Moreover, we found a significant restriction concerning global health and emotional and social functioning in this group 1 year after surgery. 2 years postoperatively, hardly any differences between the operative techniques could be detected. The only symptom in favor of the MER procedure was a better dysphagia score postoperatively. CONCLUSION Our study suggests that MER procedure is not superior to subtotal esophagectomy with regard to HRQL.
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Affiliation(s)
- Ch Zapletal
- Department of Surgery, Dr. Horst-Schmidt-Klinik, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany,
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30
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Predicting blood transfusion in patients undergoing minimally invasive oesophagectomy. Int J Surg 2014; 12:1342-7. [PMID: 25448656 DOI: 10.1016/j.ijsu.2014.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/07/2014] [Accepted: 10/19/2014] [Indexed: 12/20/2022]
Abstract
AIM To evaluate predictors of allogenic blood transfusion requirements in patients undergoing minimal invasive oesophagectomy at a tertiary high volume centre for oesophago-gastric surgery. METHODS Retrospective analysis of all patients undergoing minimal access oesophagectomy in our department between January 2010 and December 2011. Patients were divided into two groups depending on whether they required a blood transfusion at any time during their index admission. Factors that have been shown to influence perioperative blood transfusion requirements in major surgery were included in the analysis. Binary logistic regression analysis was performed to determine the impact of patient and perioperative characteristics on transfusion requirements during the index admission. RESULTS A total of 80 patients underwent minimal access oesophagectomy, of which 61 patients had a laparoscopic assisted oesophagectomy and 19 patients had a minimal invasive oesophagectomy. Perioperative blood transfusion was required in 28 patients at any time during hospital admission. On binary logistic regression analysis, a lower preoperative haemoglobin concentration (p < 0.01), suffering a significant complication (p < 0.005) and laparoscopic assisted oesophagectomy (p < 0.05) were independent predictors of blood transfusion requirements. DISCUSSION It has been reported that requirement for blood transfusion can affect long-term outcomes in oesophageal cancer resection. Two factors which could be addressed preoperatively; haemoglobin concentration and type of oesophageal resection, may be valuable in predicting blood transfusions in patients undergoing minimally invasive oesophagectomy. CONCLUSION Our analysis revealed that preoperative haemoglobin concentration, occurrence of significant complications and type of minimal access oesophagectomy predicted blood transfusion requirements in the patient population examined.
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Abstract
A substantial portion of patients diagnosed preoperatively with high grade dysplasia (HGD) alone will have occult esophageal adenocarcinoma on analysis of the surgical specimen. Therefore, because of an increased risk of disease progression and malignancy, patients with HGD should be referred for esophagectomy promptly when endoscopic therapy has failed. The required extent of lymphadenectomy in this cohort of patients is unknown because of the variable incidence of submucosal cancer observed. Improvements in perioperative care, adoption of a minimally invasive surgical approach, and centralization of esophageal cancer services have substantially reduced the rates of mortality and morbidity associated with esophagectomy in recent years. Minimally invasive esophagectomy should be considered the treatment of choice in patients with dysplastic Barrett's esophagus that is refractory to endoscopic therapy or those at high risk of invasive cancer.
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32
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Rees JR, Blazeby JM, Brookes ST, John T, Welsh FK, Rees M. Patient-reported outcomes in long-term survivors of metastatic colorectal cancer needing liver resection. Br J Surg 2014; 101:1468-74. [DOI: 10.1002/bjs.9620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 06/27/2014] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Five-year survival after hepatic resection for colorectal cancer (CRC) liver metastases is good, but data on patient-reported outcomes are lacking. This study describes the long-term impact of liver surgery for CRC metastases on patient-reported outcomes.
Methods
The study used the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and the disease-specific module, EORTC QLQ-LMC21. For functional scales, mean scores out of 100 with 95 per cent c.i. were calculated; differences of 10 points or more were considered clinically significant. Responses to symptom scales and items were categorized as ‘minimal’ or ‘severe’. Proportions and 95 per cent c.i. for symptoms were calculated.
Results
A total of 241 patients were recruited; nine (3·7 per cent) had unresectable disease and were excluded. Some 68 (42 men) of 80 long-term survivors participated; their mean age was 69·5 years and median follow-up was 8·0 (range 6·9–9·2) years. Values for baseline and 1-year patient-reported outcome data were similar. Scores for functional scales were excellent (emotional function: 92, 95 per cent c.i. 87 to 96; social function: 94, 89 to 99; role function: 94, 90 to 98), reflecting clinically significant improvements from baseline values of 17 (10 to 24), 12 (3 to 21) and 12 (3 to 20) respectively. Severe symptoms were uncommon (affected less than 5 per cent of patients) for most patient-reported outcome scales or items, but persistent severe symptoms were noted for sexual function (2 per cent increase from baseline), peripheral neuropathy (2 per cent increase), constipation (10 per cent increase) and diarrhoea (5 per cent increase).
Conclusion
Long-term survivors of metastatic colorectal cancer who have undergone liver surgery have excellent global quality of life, high levels of function and few symptoms.
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Affiliation(s)
- J R Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, Basingstoke, UK
| | - S T Brookes
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Basingstoke, UK
| | - T John
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - F K Welsh
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - M Rees
- Department of Hepatobiliary Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Avery KNL, Metcalfe C, Berrisford R, Barham CP, Donovan JL, Elliott J, Falk SJ, Goldin R, Hanna G, Hollowood AA, Krysztopik R, Noble S, Sanders G, Streets CG, Titcomb DR, Wheatley T, Blazeby JM. The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer--the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial. Trials 2014; 15:200. [PMID: 24888266 PMCID: PMC4084574 DOI: 10.1186/1745-6215-15-200] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/22/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer. METHODS/DESIGN A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff. DISCUSSION The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer. TRIAL REGISTRATION The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at http://www.controlled-trials.com; the ROMIO trial record at that site gives a link to the original version of the study protocol.
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Affiliation(s)
- Kerry NL Avery
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Richard Berrisford
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - C Paul Barham
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Jackie Elliott
- Gastro-Oesophageal Support and Help Group, 15 Honey Hill Road, BS15 4HG Kingswood, South Gloucestershire, UK
| | - Stephen J Falk
- Bristol Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Horfield Road, BS2 8ED Bristol, UK
| | - Rob Goldin
- Centre for Pathology, 4th Floor Clarence Wing, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
| | - George Hanna
- Department of Bio-Surgery & Surgical Technology, Imperial College NHS Trust, Academic Surgical Unit, 10th Floor, QEQM Building, St. Mary’s Hospital, Praed Street, W2 1NY London, UK
| | - Andrew A Hollowood
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Richard Krysztopik
- Gastroenterology & Surgical Department B57, Royal United Hospital Bath NHS Trust, Combe Park, BA1 3NG Bath, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
| | - Grant Sanders
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - Christopher G Streets
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Dan R Titcomb
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
| | - Tim Wheatley
- Department of Upper Gastrointestinal Surgery, Derriford Hospital, Derriford Road, PL6 8DH Plymouth, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, BS8 2PS, Clifton Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, BS1 3NU Bristol, UK
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Jacobs M, Macefield RC, Elbers RG, Sitnikova K, Korfage IJ, Smets EMA, Henselmans I, van Berge Henegouwen MI, de Haes JCJM, Blazeby JM, Sprangers MAG. Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery. Qual Life Res 2014; 23:1155-76. [PMID: 24293086 DOI: 10.1007/s11136-013-0576-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of the study is to (1) estimate the direction, clinical relevance, and duration of health-related quality-of-life (HRQL) change in the first year following esophageal cancer surgery and (2) to assess the robustness of the estimates by subgroup and sensitivity analyses, and an exploration of publication bias. METHODS A systematic literature search in MEDLINE, EMBASE, CINAHL, PsychINFO, and CENTRAL to identify randomized and non-randomized studies was performed. We compared the baseline HRQL data with 3-, 6-, 9-, or 12-month follow-ups to estimate the magnitude and duration of HRQL change. These estimates were then classified as trivial, small, medium, or large. Primary outcomes were role functioning, eating, and fatigue. Secondary outcomes were physical and social functioning, dysphagia, pain, and coughing problems. We conducted subgroup analysis for open surgery, open surgery preceded by neoadjuvant therapy, and minimally invasive surgery. Sensitivity analyses assessed the influence of study design, transformation/imputation of the data, and HRQL questionnaire used. RESULTS We included the data from 15 studies to estimate the change in 28 HRQL outcomes after esophageal cancer surgery. The main analysis showed that patients' social functioning deteriorated. Symptoms of fatigue, pain, and coughing problems increased. These changes lasted for 9-12 months, although some symptoms persisted beyond the first year after surgery. For many other HRQL outcomes, estimates were only robust after subgroup or sensitivity analyses (e.g., role and physical functioning), or remained too heterogeneous to interpret (e.g., eating and dysphagia). CONCLUSIONS Patients will experience a clinically relevant and long-lasting deterioration in HRQL after esophageal cancer surgery. However, for many HRQL outcomes, more and better quality evidence is needed.
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Affiliation(s)
- M Jacobs
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Meibergdreef 5, PO Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Macefield RC, Jacobs M, Korfage IJ, Nicklin J, Whistance RN, Brookes ST, Sprangers MAG, Blazeby JM. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs). Trials 2014; 15:49. [PMID: 24495582 PMCID: PMC3916696 DOI: 10.1186/1745-6215-15-49] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/17/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. METHODS Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. RESULTS Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, 'physical function' in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. CONCLUSION This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials.
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Affiliation(s)
- Rhiannon C Macefield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Marc Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, P.O. Box 2040, Rotterdam NL 3000 CA, Netherlands
| | - Joanna Nicklin
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Robert N Whistance
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sara T Brookes
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Mirjam AG Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Meibergdreef 5, Amsterdam NL 1105 AZ, Netherlands
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Level 3, Dolphin House, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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Update on clinical impact, documentation, and management of complications associated with esophagectomy. Thorac Surg Clin 2013; 23:535-50. [PMID: 24199703 DOI: 10.1016/j.thorsurg.2013.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The assessment and monitoring of complications associated with esophageal resection suffers from the absence of an internationally recognized system for documenting the incidence and severity of complications. The impact of complications is significant, with direct effects being identified on mortality, length of stay, postoperative quality of life, and long-term survival. Newer systems of assessing surgical complication severity and the resources required to treat complications include the Accordion and Clavien grading systems. New endoscopic and interventional approaches to treating anastomotic leak and stricture and chyle leak can selectively decrease length of stay and costs of managing complications.
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Jacobs M, Macefield RC, Elbers RG, Sitnikova K, Korfage IJ, Smets EMA, Henselmans I, van Berge Henegouwen MI, de Haes JCJM, Blazeby JM, Sprangers MAG. Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery. Qual Life Res 2013; 23:1097-115. [PMID: 24129668 DOI: 10.1007/s11136-013-0545-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study is to (1) estimate the direction, clinical relevance, and duration of health-related quality of life (HRQL) change in the first year following esophageal cancer surgery and (2) to assess the robustness of the estimates by subgroup and sensitivity analyses, and an exploration of publication bias. METHODS A systematic literature search in MEDLINE, EMBASE, CINAHL, PsychINFO, and CENTRAL to identify randomized and non-randomized studies was performed. We compared the baseline HRQL data with 3-, 6-, 9-, or 12-month follow-ups to estimate the magnitude and duration of HRQL change. These estimates were then classified as trivial, small, medium, or large. Primary outcomes were role functioning, eating, and fatigue. Secondary outcomes were physical and social functioning, dysphagia, pain, and coughing problems. We conducted subgroup analysis for open surgery, open surgery preceded by neo-adjuvant therapy, and minimally invasive surgery. Sensitivity analyses assessed the influence of study design, transformation/imputation of the data, and HRQL questionnaire used. RESULTS We included data from 15 studies to estimate the change in 28 HRQL outcomes after esophageal cancer surgery. The main analysis showed that patients' social functioning deteriorated. Symptoms of fatigue, pain, and coughing problems increased. These changes lasted for 9-12 months, although some symptoms persisted beyond the first year after surgery. For many other HRQL outcomes, estimates were only robust after subgroup or sensitivity analyses (e.g., role and physical functioning), or remained too heterogeneous to interpret (e.g., eating and dysphagia). CONCLUSIONS Patients will experience a clinically relevant and long-lasting deterioration in HRQL after esophageal cancer surgery. However, for many HRQL outcomes, more and better quality evidence is needed.
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Affiliation(s)
- M Jacobs
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 5, 1100DD, Amsterdam, The Netherlands,
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Cash JC, Zehetner J, Hedayati B, Bildzukewicz NA, Katkhouda N, Mason RJ, Lipham JC. Outcomes following laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc 2013; 28:492-9. [PMID: 24100862 DOI: 10.1007/s00464-013-3230-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 09/17/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE). METHODS Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008. RESULTS There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p < 0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p < 0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively. CONCLUSION LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.
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Affiliation(s)
- J Christian Cash
- Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St, Suite 514, Los Angeles, CA, 90033, USA
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Bronson NW, Luna RA, Hunter JG. Tailoring esophageal cancer surgery. Semin Thorac Cardiovasc Surg 2013; 24:275-87. [PMID: 23465676 DOI: 10.1053/j.semtcvs.2012.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 12/15/2022]
Abstract
Esophageal cancer is a significant source of major mortality worldwide and is increasing dramatically in incidence. Without treatment this disease leads rapidly to death, but intervention also carries significant risk, so a carefully tailored approach must be used to maximize oncological efficacy while minimizing the negative consequences of intervention. Careful patient selection based on histologic and anatomic staging, consideration of each patient's clinical variables, appropriately timing chemo- and radiation therapy, and minimizing the morbidity of surgical intervention may significantly improve a patient's chances of surviving this disease, but each must be carefully orchestrated with a tailored approach to treatment. This review will serve as a guide to tailoring surgery for esophageal cancer.
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Affiliation(s)
- Nathan W Bronson
- Department of Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA
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Abstract
Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge.
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Affiliation(s)
- Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Esophageal resection remains the primary treatment for local regional esophageal cancer, although its role in superficial (T1A) cancers and squamous cell cancer is in evolution. Mortality associated with esophagectomy has historically been high but is improving with the current expectation of in-hospital mortality rates of 2-4% in high-volume centers. Most patients with regional cancers (T2-4 N0-3) are recommended for neoadjuvant therapy, which most commonly involves radiochemotherapy. Some centers have proposed treating with definitive chemoradiation and reserving surgery for patients who have persistent or recurrent disease. 'Salvage resections' are possible but are associated with higher levels of perioperative morbidity and mortality, and treatment decisions should routinely be based on multidisciplinary discussion in the tumor board. Although open surgical resection (both transthoracic and transhiatal operations) remain the most common approach, minimally invasive or hybrid operations are being done in up to 30% of procedures internationally. There are some indications that minimally invasive esophagectomy may decrease the incidence of respiratory complications and decrease length of stay. At this point, oncologic outcomes appear equivalent between open and minimally invasive procedures. Recent reviews from high-volume esophagectomy centers demonstrate that elderly patients can selectively undergo esophagectomy with the expectation of increased complications but similar mortality and survival to younger patients. Multiple studies confirm that quality of life following esophagectomy can be equivalent to the general population when surgery is done in experienced centers. Patients requiring surgical treatment of esophageal cancer should be referred to high-volume centers, especially those with established care pathways or enhanced recovery programs to improve outcomes including morbidity, mortality, survival, and quality of life.
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Affiliation(s)
- Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA 98111, USA.
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Noble F, Kelly JJ, Bailey IS, Byrne JP, Underwood TJ. A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Dis Esophagus 2013; 26:263-71. [PMID: 23551569 DOI: 10.1111/j.1442-2050.2012.01356.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The majority of esophagectomies in Western parts of the world are performed by a transthoracic approach reflecting the prevalence of adenocarcinoma of the lower esophagus or esophagogastric junction. Minimally invasive esophagectomy (MIE) has been reported in a variety of formats, but there are no series that directly compare totally minimally invasive thoracolaparoscopic 2 stage esophagectomy (MIE-2) with open Ivor Lewis (IVL). A prospective single-center cohort study of patients undergoing elective MIE-2 or IVL between January 2005 and November 2010 was performed. Short-term clinicopathologic outcomes were recorded using validated systems. One hundred and six patients (median age 66, range 36-85, 88 M : 18 F) underwent two-stage esophagectomy (53 MIE-2 and 53 IVL). Patient demographics (age, sex, body mass index, American Society of Anesthesiologists grade, tumor characteristics, neoadjuvant chemotherapy, and TNM stage) were comparable between the two groups. Outcomes for MIE-2 and IVL were comparable for anastomotic leak rates (5 [9%] vs. 2 [4%], P= 0.241), resection margin clearance (R0) (43 [81%] vs. 38 [72%], P= 0.253), median lymph node yield (19 vs. 18, P= 0.584), and median length of stay (12 [range 7-91] vs. 12 [range 7-101] days), respectively. Blood loss was significantly less for MIE-2 compared with IVL (median 300 [range 0-1250] mL vs. 400 [range 0-3000] mL, respectively, P= 0.021). MIE-2 in this series of selected patients supports its efficacy, when performed by an experienced minimally invasive surgical team. A well-designed multicenter trial addressing clinical effectiveness is now required.
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Affiliation(s)
- F Noble
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
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Parameswaran R, Titcomb DR, Blencowe NS, Berrisford RG, Wajed SA, Streets CG, Hollowood AD, Krysztopik R, Barham CP, Blazeby JM. Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers. Ann Surg Oncol 2013; 20:1970-7. [PMID: 23306956 DOI: 10.1245/s10434-012-2848-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) may lead to early restoration of health-related quality of life, but few prospective comparative studies have been performed. This exploratory study compared recovery between totally minimally invasive esophagectomy (MIE), laparoscopically assisted esophagectomy (LAE) and open surgery (OE). METHODS A prospective study in 2 specialist centers recruited consecutive patients undergoing OE, LAE, or MIE for high-grade dysplasia or cancer. Patients completed validated questionnaires, the Multi-Dimensional Fatigue Inventory (MFI-20), modified Katz Scale, and modified Lawton and Brody Scale (assessing activities of daily living) before and 6 weeks and 3 and 6 months after surgery. RESULTS A total of 97 patients (26 women; median age 64 years) were scheduled for surgery that was abandoned in 11 due to occult low-volume metastatic disease. In the remaining 86 (OE = 19, LAE = 31, and MIE = 36), there were 4 in-hospital deaths (4 %), and 54 postoperative complications (OE = 12, LAE = 19, and MIE = 23). Overall questionnaire compliance was high (77 %) and baseline scores similar in all groups, although clinical differences between groups were observed with earlier tumors and more squamous cell cancers selected for MIE. Following surgery fatigue levels increased dramatically and activity levels reduced in all groups. These gradually recovered to baseline following MIE and LAE within 6 months, but the ability to perform activities of daily living and most parameters of fatigue had not returned to baseline levels in the OE group. CONCLUSIONS This exploratory prospective nonrandomized study of recovery after different types of surgery for esophageal cancer showed possible small benefits to MIE. A much larger study is needed to confirm these findings.
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Affiliation(s)
- R Parameswaran
- Department of Thoracic and Upper GI Surgery, The Royal Devon and Exeter Hospital Foundation Trust, Exeter, United Kingdom.
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Wolter S, Mann O, Izbicki JR. Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Ösophagus - Pro-Position. Visc Med 2013; 29:344-348. [DOI: 10.1159/000357486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
<b><i>Hintergrund: </i></b>Die offene onkologische Resektion ist derzeit der Goldstandard in der Behandlung des Plattenepithel- und Adenokarzinoms des Ösophagus. Die mit den Therapieverfahren assoziierte Morbidität und Mortalität konnte in den letzten Jahren durch die Verbesserung des chirurgischen und perioperativen Managements deutlich gesenkt werden, bleibt aber im Vergleich zu anderen Eingriffen am Gastrointestinaltrakt weiterhin hoch. <b><i>Methoden: </i></b>Diese Übersicht basiert auf einer strukturierten Analyse der aktuellen, in MEDLINE, PubMed, EMBASE und den Cochrane Databases gelisteten Studien. <b><i>Ergebnisse: </i></b>In den letzten 20 Jahren sind zunehmend Arbeiten erschienen, die seit der Erstbeschreibung der minimalinvasiven Ösophagusresektion zeigen, dass in entsprechend erfahrenen Zentren die hohe Morbidität und Mortalität, insbesondere für pulmonale Komplikationen durch minimalinvasive Ösophagusresektionen, drastisch gesenkt werden konnte - ohne Verzicht auf onkologische Radikalität und ohne Verschlechterung des onkologischen Outcomes. Die postoperative Lebensqualität war ebenfalls nicht schlechter für minimalinvasiv operierte Patienten. Allerdings sind die minimalinvasiven Techniken im Bereich der Ösophaguschirurgie mit einer signifikanten Lernkurve verbunden - ein weiteres Argument für eine Zentralisierung der Ösophaguschirurgie. <b><i>Schlussfolgerungen: </i></b>Die bisher erhobenen Daten zur minimalinvasiven Ösophagusresektion sind zwar sehr vielversprechend, jedoch sind weitere kontrollierte randomisierte Studien erforderlich, um die bisher erhobenen Daten zu erhärten.
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Systematic review reveals limitations of studies evaluating health-related quality of life after potentially curative treatment for esophageal cancer. Qual Life Res 2012; 22:1787-803. [DOI: 10.1007/s11136-012-0290-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 12/21/2022]
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Zeng J, Liu JS. Quality of life after three kinds of esophagectomy for cancer. World J Gastroenterol 2012; 18:5106-13. [PMID: 23049222 PMCID: PMC3460340 DOI: 10.3748/wjg.v18.i36.5106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/08/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate quality of life (QOL) following Ivor Lewis, left transthoracic, and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.
METHODS: Ninety patients with esophageal cancer were assigned to Ivor Lewis (n = 30), combined thoracoscopic/laparoscopic (n = 30), and left transthoracic (n = 30) esophagectomy groups. The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer, both developed by the European Organization for Research and Treatment of Cancer, were used to evaluate patients’ QOL from 1 wk before to 24 wk after surgery.
RESULTS: A total of 324 questionnaires were collected from 90 patients; 36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits. QOL declined markedly in all patients at 1 wk postoperatively: preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis, combined thoracoscopic/laparoscopic, and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1 (P < 0.001), 81.1 ± 9.0 vs 53.3 ± 11.5 (P < 0.001), and 83.6 ± 11.2 vs 46.4 ± 11.3 (P < 0.001), respectively. Thereafter, QOL recovered gradually in all patients. Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL; global scores were lower in this group than in the combined thoracoscopic/laparoscopic (P < 0.001) and left transthoracic (P < 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively. QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy, and most indices had recovered to preoperative levels at 24 wk postoperatively. In the Ivor Lewis and combined thoracoscopic/laparoscopic groups, pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9 (P < 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2 (P = 0.02), respectively, at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6 (P = 0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3 (P = 0.003), respectively, at 24 wk postoperatively. Scores in the left transthoracic esophagectomy group fell between those of the other two groups.
CONCLUSION: Compared with Ivor Lewis and left transthoracic esophagectomies, combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL, making it a preferable surgical approach for esophageal cancer.
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Kim T, Hochwald SN, Sarosi GA, Caban AM, Rossidis G, Ben-David K. Review of minimally invasive esophagectomy and current controversies. Gastroenterol Res Pract 2012; 2012:683213. [PMID: 22919374 PMCID: PMC3419416 DOI: 10.1155/2012/683213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/01/2012] [Accepted: 06/08/2012] [Indexed: 01/09/2023] Open
Abstract
Esophagectomy is a complex operation with significant morbidity and mortality. Minimally invasive esophagectomy (MIE) was described in the 1990s in an effort to reduce operative morbidity. Since then many institutions have adopted and described their series with this technique. This paper reviews the literature on the variety of MIE techniques, clinical and quality of life outcomes with open versus MIE, and controversies surrounding MIE-such as prone positioning, stapling techniques, size of the gastric conduit, and robotic techniques.
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Affiliation(s)
- T. Kim
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - S. N. Hochwald
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - G. A. Sarosi
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - A. M. Caban
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - G. Rossidis
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
| | - K. Ben-David
- Department of Surgery, College of Medicine, University of Florida, P.O. Box 100109, Gainesville, FL 32610-0109, USA
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49
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Gutschow CA, Hölscher AH, Leers J, Fuchs H, Bludau M, Prenzel KL, Bollschweiler E, Schröder W. Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg 2012; 398:231-7. [PMID: 22661100 DOI: 10.1007/s00423-012-0960-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/09/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Transthoracic Ivor Lewis esophagectomy is a surgical standard therapy for esophageal carcinoma. The aim of this study was to assess health-related quality of life (HRQL) in mid- and long-term survivors. METHODS Patients with cancer-free survival of at least 12 months after esophageal resection for cancer were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and esophageal cancer-specific (QLQ-OES18) quality of life (QOL). A numeric score was calculated in each conceptual area and compared with reference data. RESULTS One hundred forty-seven patients completed the self-rated questionnaires. They were 121 men and 26 women with a mean age of 63.4 (21-83) years; median FU was 39 (12-139) months. Global health status, functional scales, and symptom scores were significantly reduced compared with healthy reference populations. Also, there was no significant impact of tumor histology, neoadjuvant treatment, minimally invasive approach, or duration of follow-up on HRQL. However, more than half of the patients reported a HRQL similar to that of the healthy reference population. CONCLUSIONS Despite the major psychosocial and physiological impacts of the disease, more than 50 % of mid- and long-term survivors of the Ivor Lewis procedure for esophageal cancer have a HRQL similar to that of the healthy reference population.
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Affiliation(s)
- Christian A Gutschow
- Department of General, Visceral, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, Cologne, Germany.
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50
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Biere SSAY, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JHG, Hollmann MW, de Lange ESM, Bonjer HJ, van der Peet DL, Cuesta MA. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379:1887-92. [PMID: 22552194 DOI: 10.1016/s0140-6736(12)60516-9] [Citation(s) in RCA: 1144] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection is regarded as the only curative option for resectable oesophageal cancer, but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern. We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy. METHODS We did a multicentre, open-label, randomised controlled trial at five study centres in three countries between June 1, 2009, and March 31, 2011. Patients aged 18-75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were randomly assigned via a computer-generated randomisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy. Randomisation was stratified by centre. Patients, and investigators undertaking interventions, assessing outcomes, and analysing data, were not masked to group assignment. The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital. Analysis was by intention to treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. FINDINGS We randomly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group. 16 (29%) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five (9%) in the minimally invasive group (relative risk [RR] 0·30, 95% CI 0·12-0·76; p=0·005). 19 (34%) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven (12%) in the minimally invasive group (0·35, 0·16-0·78; p=0·005). For in-hospital mortality, one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage. INTERPRETATION These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer. FUNDING Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre.
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Affiliation(s)
- Surya S A Y Biere
- Department of Surgery, VU University Medical Centre, Amsterdam, Netherlands
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