title: Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers.
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.
authors.affiliation: Department of Thoracic and Upper GI Surgery, The Royal Devon and Exeter Hospital Foundation Trust, Exeter, United Kingdom. drrajeev_p@yahoo.com
authors.forename: R
authors.initials: R
authors.lastname: Parameswaran
authors.forename: D R
authors.initials: DR
authors.lastname: Titcomb
authors.forename: N S
authors.initials: NS
authors.lastname: Blencowe
authors.forename: R G
authors.initials: RG
authors.lastname: Berrisford
authors.forename: S A
authors.initials: SA
authors.lastname: Wajed
authors.forename: C G
authors.initials: CG
authors.lastname: Streets
authors.forename: A D
authors.initials: AD
authors.lastname: Hollowood
authors.forename: R
authors.initials: R
authors.lastname: Krysztopik
authors.forename: C P
authors.initials: CP
authors.lastname: Barham
authors.forename: J M
authors.initials: JM
authors.lastname: Blazeby
mesh_terms: D000203:Activities of Daily Living; D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D020360:Neoadjuvant Therapy; D061646:Operative Time; D011795:Surveys and Questionnaires
chemical_list: D002945:Cisplatin; D005472:Fluorouracil