Joonas H Kauppila1,2,3, Asif Johar1, Pernilla Lagergren1,4. 1. Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 2. Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland. 3. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Surgery and Cancer, Imperial College London, London, UK.
Abstract
OBJECTIVE: To evaluate the impact of postoperative medical and surgical complications on health-related quality of life (HRQOL) in esophageal cancer. BACKGROUND: Complications after esophageal surgery negatively affect HRQOL, but it is unclear whether medical and surgical complications differ in effects. METHODS: This Swedish population-based, nationwide, and prospective cohort study enrolled 616 patients undergoing esophageal cancer surgery during 2001 to 2005, with 10 years of follow-up. The exposure was the occurrence of the predefined postoperative medical or surgical technical complications. The study outcome was HRQOL, evaluated by European Organisation for Research and Treatment of Cancer questionnaires at 6 months, and 3, 5, and 10 years after surgery. Linear mixed models, adjusted for confounders and complications, provided mean score differences (MDs) and 95% confidence intervals (CIs) for each HRQOL scale and item. RESULTS: Of the 616 patients, 217 (35%) had medical and 163 (26%) had surgical postoperative complications. In patients with medical complications, HRQOL was generally worse at all time points, with worse global quality of life (QOL) (MD -10, 95% CI -18 to -2) and dyspnea (MD 16, 95% CI 5-27) from 3 years onwards, compared with those without. Patients with surgical complications had worse HRQOL outcomes up to 5 years after surgery, for example, dyspnea at 6 months (MD 11, 95% CI 4-19) and global QOL at 3 years (MD -13, 95% CI -22 to -5), than those without. CONCLUSION: Medical complications are associated with long-lasting impairments and worsening HRQOL, whereas the negative effects of surgical complications on HRQOL seem to minimize 5 years postsurgery.
OBJECTIVE: To evaluate the impact of postoperative medical and surgical complications on health-related quality of life (HRQOL) in esophageal cancer. BACKGROUND: Complications after esophageal surgery negatively affect HRQOL, but it is unclear whether medical and surgical complications differ in effects. METHODS: This Swedish population-based, nationwide, and prospective cohort study enrolled 616 patients undergoing esophageal cancer surgery during 2001 to 2005, with 10 years of follow-up. The exposure was the occurrence of the predefined postoperative medical or surgical technical complications. The study outcome was HRQOL, evaluated by European Organisation for Research and Treatment of Cancer questionnaires at 6 months, and 3, 5, and 10 years after surgery. Linear mixed models, adjusted for confounders and complications, provided mean score differences (MDs) and 95% confidence intervals (CIs) for each HRQOL scale and item. RESULTS: Of the 616 patients, 217 (35%) had medical and 163 (26%) had surgical postoperative complications. In patients with medical complications, HRQOL was generally worse at all time points, with worse global quality of life (QOL) (MD -10, 95% CI -18 to -2) and dyspnea (MD 16, 95% CI 5-27) from 3 years onwards, compared with those without. Patients with surgical complications had worse HRQOL outcomes up to 5 years after surgery, for example, dyspnea at 6 months (MD 11, 95% CI 4-19) and global QOL at 3 years (MD -13, 95% CI -22 to -5), than those without. CONCLUSION: Medical complications are associated with long-lasting impairments and worsening HRQOL, whereas the negative effects of surgical complications on HRQOL seem to minimize 5 years postsurgery.
Authors: Xi Luo; Qin Xie; Qiuling Shi; Yan Miao; Qingsong Yu; Hongfan Yu; Hong Yin; Xuefeng Leng; Yongtao Han; Hong Zhou Journal: Support Care Cancer Date: 2021-11-24 Impact factor: 3.603
Authors: Sheraz Rehan Markar; Ewen A Griffiths; Paul Behrens; Pritam Singh; Ravi S Vohra; James Gossage; Tim Underwood; George B Hanna Journal: BMJ Open Date: 2020-06-03 Impact factor: 2.692
Authors: Philip H Pucher; Annie Coombes; Orla Evans; Joanna Taylor; Jonathan L Moore; Annabelle White; Jesper Lagergren; Cara Baker; Mark Kelly; James A Gossage; Jason Dunn; Sebastian Zeki; Ben E Byrne; Jervoise Andreyev; Andrew R Davies Journal: Support Care Cancer Date: 2022-03-11 Impact factor: 3.359