title: Influence of surgery-related factors on quality of life after esophageal or cardia cancer resection.
abstract: Knowledge of how factors related to esophageal cancer resection affect long-term quality of life after surgery is scarce, and no population-based studies are available. Therefore, we conducted a Swedish nationwide, prospective, population-based study of how esophageal surgery-related factors influence quality of life 6 months postoperatively. The Swedish Esophageal and Cardia Cancer register (SECC-register) encompasses 174 hospital departments (97%). Microscopically radically operated patients responded to a validated written questionnaire assessing quality of life. The basic questionnaire (QLQ-C30) and the esophagus-specific module (OES-24) were developed by the European Organization for Research and Treatment of Cancer. The Mann-Whitney test, the Jonckheere-Terpstras test, and logistic regression were used in statistical analyses. Among 100 included patients, the occurrence of surgery-related complications was the main predictor of reduced global quality of life 6 months after surgery (p for trend = 0.03). This effect remained after adjustment for potential confounding variables. Except for anastomotic strictures, each of the predefined complications--i.e., anastomotic leakage, infections, cardiopulmonary complications, and operative technical complications--contributed to decreased quality-of-life scores. Other potentially relevant factors--e.g. degree of lymph node dissection, resection margins, operative blood loss or duration, and hospital type--did not significantly affect quality of life. In conclusion, any measures that can reduce the risk of major surgery-related complications can decrease the negative impact on quality of life after esophageal cancer surgery. More population-based studies are warranted, however.
authors.affiliation: Department of Surgical Science, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden. pernilla.viklund@karolinska.se
authors.forename: Pernilla
authors.initials: P
authors.lastname: Viklund
authors.forename: Mats
authors.initials: M
authors.lastname: Lindblad
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002299:Cardia; D013505:Digestive System Surgical Procedures; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery; D013548:Sweden