title: Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy?
abstract: BACKGROUND
  Esophagectomy with gastric tube reconstruction and extended transhiatal gastrectomy with Roux-en-Y reconstruction are alternative procedures in current therapeutic concepts for adenocarcinoma of the esophagogastric junction (AEG). The impact of these operations on long-term health-related quality of life (HRQL) is incompletely understood.
  
  
  METHODS
  Patients with cancer-free survival of at least 24 months after esophagectomy (ESO) or extended gastrectomy (GAST) for AEG were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and cancer-specific (OG-25) quality of life. Numeric scores were calculated for each conceptual area and compared with those of healthy reference populations.
  
  
  RESULTS
  123 patients (ESO n = 71; GAST n = 52) completed the self-rated questionnaires. HRQL was consistently lower in surgical patients (GAST and ESO) compared with healthy reference populations. Also, there was a general trend for a better HRQL in GAST compared with ESO patients. This trend was statistically significant for physical function (p = 0.04), dyspnea (p = 0.02), and reflux (p = 0.03). Subgroup analysis revealed no significant differences between patients with or without prior neoadjuvant therapy.
  
  
  CONCLUSIONS
  After mid- and long-term follow-up, HRQL after extended gastrectomy with Roux-en-Y reconstruction is superior to that after esophagectomy and gastric tube reconstruction. Improved HRQL after gastrectomy is mainly due to less pulmonary and reflux-related symptoms. Our findings may influence the choice of the surgical strategy for patients with AEG.
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Hans
authors: H
authors: Fuchs
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Arnulf H
authors: AH
authors: Hölscher
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Jessica
authors: J
authors: Leers
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Marc
authors: M
authors: Bludau
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Sebastian
authors: S
authors: Brinkmann
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Wolfgang
authors: W
authors: Schröder
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Hakan
authors: H
authors: Alakus
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
authors: Stefan
authors: S
authors: Mönig
authors: Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany. christian.gutschow@uk-koeln.de.
authors: Christian A
authors: CA
authors: Gutschow
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Esophagogastric junction cancer; Quality of life; Surgery
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