Health-Related Quality of Life, Cachexia and Overall Survival After Major Upper Abdominal Surgery: A Prospective Cohort Study.
OBJECTIVE
Major upper abdominal surgery is often associated with reduced health-related quality of life and reduced survival. Patients with upper abdominal malignancies often suffer from cachexia, represented by preoperative weight loss and sarcopenia (low skeletal muscle mass) and this might affect both health-related quality of life and survival. We aimed to investigate how health-related quality of life is affected by cachexia and how health-related quality of life relates to long-term survival after major upper abdominal surgery.


METHODS
From 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. In this study, six years later, these patients were analyzed as a single prospective cohort and survival data were retrieved from the National Population Registry. Cachexia was derived from patient-reported preoperative weight loss and sarcopenia as assessed from computed tomography images taken within three months preoperatively. In the original trial, self-reported health-related quality of life was assessed preoperatively at trial enrollment and eight weeks postoperatively with the health-related quality of life questionnaire Short Form 36.


RESULTS
A majority of the patients experienced improved mental health-related quality of life and, to a lesser extent, deteriorated physical health-related quality of life following surgery. There was a significant association between preoperative weight loss and reduced physical health-related quality of life. No association between sarcopenia and health-related quality of life was observed. Overall survival was significantly associated with physical health-related quality of life both pre- and postoperatively, and with postoperative mental health-related quality of life. The association between health-related quality of life and survival was particularly strong for postoperative physical health-related quality of life.


CONCLUSIONS
Postoperative physical health-related quality of life strongly correlates with overall survival after major upper abdominal surgery.
1 Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway.|2 Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.
E K
EK
Aahlin
3 Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
G
G
Tranø
4 Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.
N
N
Johns
5 Department of Abdominal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
A
A
Horn
6 Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.|7 Department of Clinical Medicine, University of Bergen, Bergen, Norway.
J A
JA
Søreide
4 Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.
K C
KC
Fearon
1 Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway.|2 Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.
A
A
Revhaug
1 Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway.|2 Institute of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.
K
K
Lassen
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002100:Cachexia / Q000150:complications*; D004066:Digestive System Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D055948:Sarcopenia / Q000150:complications*; D057566:Self Report; D015996:Survival Rate; D016896:Treatment Outcome
Health-related quality of life; cachexia; cancer; recovery; sarcopenia; surgery; weight loss