title: The influence of surgical factors on persisting symptoms 3 years after esophageal cancer surgery: a population-based study in Sweden.
abstract: BACKGROUND
  Little is known about the long-term effects of surgical approach and type of anastomosis in the surgical treatment of esophageal cancer on patient-reported outcomes.
  
  
  METHODS
  A Swedish nationwide, population-based cohort study included patients undergoing esophagectomy for esophageal cancer in 2001-2005. The predefined exposures included surgical approach (transhiatal or transthoracic) and anastomotic technique (hand-sewn or mechanical). The outcomes were esophageal-specific symptoms 3 years after the surgery. Symptoms were measured using the cancer-specific quality of life questionnaire, the QLQ-C30, supplemented by an esophageal cancer-specific module (QLQ-OES18), both developed by the European Organisation for Research and Treatment of Cancer. Logistic regression models were used to estimate relative risk, expressed as odds ratios (OR) with 95 % confidence intervals (CI), of experiencing symptoms as assessed by the questionnaires.
  
  
  RESULTS
  Among the 178 included patients, there was an 84 % participation rate. No statistically significant differences were found regarding surgical approach. However, point estimates indicate that patients operated on with a transhiatal approach had a lower risk for symptoms of nausea and vomiting (OR = 0.5, 95 % CI 0.1-1.9), diarrhea (OR = 0.5, 95 % CI 0.2-1.8), and trouble swallowing (OR = 0.4, 95 % CI 0-3), and a slightly higher risk for loss of appetite (OR = 2, 95 % CI 0.7-5.6) compared with patients operated on with a transthoracic approach. Anastomotic technique did not seem to influence the risk for any of the selected symptoms.
  
  
  CONCLUSIONS
  Surgical approach and type of anastomosis do not seem to influence the risk of general and esophageal-specific cancer symptoms 3 years after surgery for esophageal cancer.
authors.affiliation: Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. maartje.van.der.schaaf@ki.se
authors.forename: Maartje
authors.initials: M
authors.lastname: van der Schaaf
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001066:Appetite; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013548:Sweden; D013997:Time Factors; D014839:Vomiting / Q000209:etiology