title: Does the site of anastomosis for esophagectomy affect long-term quality of life?
abstract: Long-term survival after esophagectomy is improving, and hence, quality of life (QOL) of these patients has become a priority. There has been extensive debate regarding the optimal site of surgical anastomosis (cervical or intrathoracic). We aimed to evaluate the impact of anastomotic site on long-term QOL postesophagectomy. Quality of life questionnaires (European Organisation for Research and Treatment of Cancer [EORTC] C-30 and OG-25) were sent to patients surviving over 3 years following esophagectomy. The data were analyzed by site of esophagogastric anastomosis: intrathoracic or cervical. EORTC C-30 data were compared against the reference population data. Of the patients, 62 responded (82%) with a median time postsurgery of 6.1 years (range 3-12 years). Patient demographics were comparable. There was no significant difference between cervical or intrathoracic anastomosis groups for functional or symptom scores, focusing on dysphagia (cervical = 8.8 vs. intrathoracic = 17.6, P = 0.24), odynophagia (cervical = 13.4 vs. intrathoracic = 16.1, P = 0.68) and swallowing problems (cervical = 8.1 vs. intrathoracic = 13.4, P = 0.32). There was no difference in overall health score between groups (cervical = 70.5 vs. intrathoracic = 71.6, P = 0.46). Overall general health score was comparable with the reference population (esophagectomy group P = 70.9 ± 22.1 vs. reference population = 71.2 ± 22.4, P = 0.93). There is no difference in long-term QOL after esophagectomy between patients with a cervical or intrathoracic anastomosis. Scores compare favorably with EORTC reference data. Survival after esophagectomy is associated with recovery of QOL in the long term, regardless of site of anastomosis and despite worse gastrointestinal-related symptoms.
authors.affiliation: Department of Surgery, North West London Hospitals Trust, Middlesex, UK.
authors.forename: J C R
authors.initials: JC
authors.lastname: Wormald
authors.affiliation: Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Bennett
authors.affiliation: Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: M
authors.initials: M
authors.lastname: van Leuven
authors.affiliation: Upper GI Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: M P N
authors.initials: MP
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D017741:Survivors / Q000523:psychology; D006113:United Kingdom / Q000453:epidemiology
keywords: anastomosis; esophageal neoplasm; esophagectomy; long-term survivor; outcome assessment; quality of life