Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer.
OBJECTIVE
The reported morbidity and mortality associated with esophagectomy for high-grade dysplasia (HGD) and intramucosal cancer (IMC) have led asymptomatic patients to consider less invasive and possibly less effective treatments. This study provides a critical assessment of outcomes and health-related quality of life (HRQL) after esophagectomy for HGD and IMC.


METHODS
Cohort analytic study.


METHODS
Section of thoracic surgery at a tertiary referral center.


METHODS
All patients who presented between May 1991 and February 2003 with a biopsy-proven diagnosis of Barrett esophagus with HGD or IMC were assessed.


METHODS
Prospective analysis of postoperative morbidity, mortality, HRQL, and gastrointestinal symptoms.


RESULTS
Follow-up was complete in 36 patients. Mean follow-up was 4.9 years (range, 0.5-12.0 years). The incidence of postoperative invasive cancer was 39%, with stages ranging from I to IIB. There were 4 major complications (11%) and no operative mortality. Twenty-eight patients were alive, with a cancer-free survival of 85%. The HRQL outcomes (Medical Outcomes Study 36-Item Short-Form Health Survey) were comparable with those of age- and sex-matched controls. Significant differences in postesophagectomy gastrointestinal symptoms were seen with a decreased incidence of heartburn (P < or = .001) and increased requirement for a slower speed of eating. Twenty-two (79%) of the 28 patients described their current eating pattern as "normal or insignificantly impacted."


CONCLUSIONS
Esophagectomy for HGD and IMC can be accomplished with low morbidity and mortality. Furthermore, most patients are able to resume a normal eating pattern, and postoperative HRQL can be equivalent to that of the general population.
Moraca
Robert J
RJ
Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, Wash 98101, USA.
Low
Donald E
DE
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D011184:Postoperative Period; D011788:Quality of Life; D016896:Treatment Outcome