title: Quality of life after surgical treatment of early Barrett's cancer: a prospective comparison of the Ivor-Lewis resection versus the modified Merendino resection.
abstract: BACKGROUND
  The Merendino (MER) procedure has been evaluated as an alternative to transthoracic esophageal resection (TER) for early stage Barrett's carcinoma. Apart from reducing morbidity and mortality, improvements concerning postoperative health-related quality of life (HRQL) have been postulated. The aim of our study was to compare HRQL between these procedures.
  
  
  METHODS
  Between July 2000 and July 2007, 117 patients with early Barrett's carcinoma underwent surgery. Patients with tumor recurrence were excluded from the study. HRQL was assessed 1 and 2 years after surgery using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (EORTC-QLQ-C30) and the QLQ-OES18 module. Patients recently diagnosed with early Barrett's carcinoma served as controls. Symptoms that showed a difference of more than ten between the control and the study groups were considered clinically relevant and were tested for significant differences between the study groups using the Mann-Whitney U test (p < 0.05).
  
  
  RESULTS
  The response rates for the questionnaires ranged between 70 and 93 %. In the MER group, more items reflected a clinical relevant impairment of HRQL than in the TER group. Significant complaints in the MER group included nausea/vomiting, appetite loss, local pain, difficulties with social eating, and choking. Moreover, we found a significant restriction concerning global health and emotional and social functioning in this group 1 year after surgery. 2 years postoperatively, hardly any differences between the operative techniques could be detected. The only symptom in favor of the MER procedure was a better dysphagia score postoperatively.
  
  
  CONCLUSIONS
  Our study suggests that MER procedure is not superior to subtotal esophagectomy with regard to HRQL.
authors.affiliation: Department of Surgery, Dr. Horst-Schmidt-Klinik, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany, czap@gmx.net.
authors.forename: Ch
authors.initials: Ch
authors.lastname: Zapletal
authors.forename: Ch
authors.initials: Ch
authors.lastname: Heesen
authors.forename: J
authors.initials: J
authors.lastname: Origer
authors.forename: M
authors.initials: M
authors.lastname: Pauthner
authors.forename: O
authors.initials: O
authors.lastname: Pech
authors.forename: Ch
authors.initials: Ch
authors.lastname: Ell
authors.forename: Dietmar
authors.initials: D
authors.lastname: Lorenz
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome