Population-based study of surgical factors in relation to health-related quality of life after oesophageal cancer resection.
BACKGROUND
Oesophagectomy for cancer has a negative impact on health-related quality of life (HRQL), but factors influencing postoperative HRQL have been sparsely studied. This study explored how selected surgical factors affected HRQL 6 months after operation.


METHODS
This population-based study was based on a Swedish network of physicians with almost complete nationwide coverage and data on oesophageal cancer surgery collected prospectively between 2001 and 2005. Patients completed validated HRQL questionnaires 6 months after operation. Mean scores with 95 per cent confidence intervals were calculated and clinically relevant differences between groups were analysed in a linear regression model, adjusted for potential confounders.


RESULTS
Some 355 patients were included in the analysis (participation rate 79.6 per cent). Extensive surgery, as indicated by a transthoracic approach, more extensive lymphadenectomy, wider resection margins and a longer duration of operation, was not associated with worse HRQL measures than less extensive operations. Dysphagia was similar in patients who had handsewn and stapled anastomoses. Technical surgical complications had significant deleterious effects on several aspects of HRQL.


CONCLUSIONS
This study provides no evidence to suggest that less extensive surgery for oesophageal cancer should be recommended from the perspective of HRQL. It is essential, however, that attention be paid to minimizing technical surgical complications.
Rutegård
M
M
Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. martin.rutegard@ki.se
Lagergren
J
J
Rouvelas
I
I
Lindblad
M
M
Blazeby
J M
JM
Lagergren
P
P
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000523:psychology; D001187:Artificial Organs / Q000523:psychology; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000523:psychology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000523:psychology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome