Lauren O'Connell1, Mary Coleman2, N Kharyntiuk2, Thomas N Walsh3. 1. Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. Electronic address: laurenoconnell@rcsi.ie. 2. Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. 3. Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland; Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland.
Abstract
BACKGROUND AND OBJECTIVES: Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS: Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS: Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS: Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
BACKGROUND AND OBJECTIVES: Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS: Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS: Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. CONCLUSIONS: Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.
Authors: Maria J Valkema; Berend J van der Wilk; Ben M Eyck; Bas P L Wijnhoven; Manon C W Spaander; Michail Doukas; Sjoerd M Lagarde; Wendy M J Schreurs; Mark J Roef; J Jan B van Lanschot; Roelf Valkema Journal: J Nucl Med Date: 2020-09-04 Impact factor: 11.082
Authors: Magnus Nilsson; Halla Olafsdottir; Gabriella Alexandersson von Döbeln; Fernanda Villegas; Giovanna Gagliardi; Mats Hellström; Qiao-Li Wang; Hemming Johansson; Val Gebski; Jakob Hedberg; Fredrik Klevebro; Sheraz Markar; Elizabeth Smyth; Pernilla Lagergren; Ghazwan Al-Haidari; Lars Cato Rekstad; Eirik Kjus Aahlin; Bengt Wallner; David Edholm; Jan Johansson; Eva Szabo; John V Reynolds; C S Pramesh; Naveen Mummudi; Amit Joshi; Lorenzo Ferri; Rebecca Ks Wong; Chris O'Callaghan; Jelena Lukovic; Kelvin Kw Chan; Trevor Leong; Andrew Barbour; Mark Smithers; Yin Li; Xiaozheng Kang; Feng-Ming Kong; Yin-Kai Chao; Tom Crosby; Christiane Bruns; Hanneke van Laarhoven; Mark van Berge Henegouwen; Richard van Hillegersberg; Riccardo Rosati; Guillaume Piessen; Giovanni de Manzoni; Florian Lordick Journal: Front Oncol Date: 2022-07-13 Impact factor: 5.738