Abstract
BackgroundSurgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality. Perioperative rehabilitation has been introduced to promote early mobilization of the patients and to prevent postoperative pulmonary complications. The purpose of the present study was to characterize the preoperative functional exercise capacity, muscle strength, anxiety, depression, and health-related quality of life (QOL) in patients with esophageal cancer, and to evaluate the impact of radical esophagectomy on these parameters.MethodsWe performed a retrospective review of 34 consecutive patients with newly diagnosed resectable esophageal cancer who underwent esophagectomy followed by postoperative rehabilitation from January to December 2014. Patients were tested for 6-min walk distance (6MWD), knee-extensor muscle strength, hand grip strength, the Hospital Anxiety and Depression Scale (HADS), and the chronic obstructive pulmonary disease (COPD) assessment test (CAT) before and two weeks after the surgery. Before surgery, the pulmonary function test, and components of the MOS 36-item Short-Form Health Survey (SF-36) Questionnaire for general health were assessed.ResultsThe mean age was 67.3 ± 8.1 years. The patients were predominantly male (76.4 %), had high rates of smoking history (91.2 %), and squamous cell carcinoma (97.1 %). The predicted value for forced expiratory volume in 1 s was 94.0 ± 15.9 %, and 12 patients (35.3 %) had COPD. The clinical stage was 0-I in 12 patients, II in 4 patients, III in 16 patients, and IV in 2 patients. Thirty-one patients (91.2 %) underwent open surgery. At the baseline, components of the SF-36 scores significantly correlated with CAT and HADS scores, and the physical status was significantly poorer in patients with COPD than those without. Comparisons between the preoperative and postoperative values revealed significant decreases in 6MWD, hand grip strength, isometric knee extensor muscle strength, and a significant increase in CAT scores but not in HADS scores after surgery. In multiple regression analysis, decreases in 6MWD after the surgery significantly correlated with the preoperative physical component summary of SF-36.ConclusionsOur results indicate that surgery remained detrimental to health outcomes at two weeks. Further research should investigate whether prehabilitation would improve the postoperative outcomes, QOL, and physical fitness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13102-016-0060-y) contains supplementary material, which is available to authorized users.
Highlights
Surgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality
Esophagectomy is the standard therapy for patients with localized esophageal cancer, but it is a highly invasive procedure and associated with serious postoperative complications such as pulmonary complications, anastomotic leaks, and sepsis [1]
The preoperative health status is important because advanced age, preoperative chemoradiotherapy, and comorbidity of chronic obstructive pulmonary disease (COPD) are associated with the increased risk of postoperative complications and mortality [4, 5]
Summary
Surgery for cancer of the thoracic esophagus is a challenging procedure associated with high morbidity and mortality. The purpose of the present study was to characterize the preoperative functional exercise capacity, muscle strength, anxiety, depression, and health-related quality of life (QOL) in patients with esophageal cancer, and to evaluate the impact of radical esophagectomy on these parameters. Perioperative rehabilitation has been expected to improve physical fitness, promote early mobilization, and reduce postoperative pulmonary complications in patients with esophageal cancer [9, 10]. In order to manage the rehabilitation program, it is important to adequately assess the status of functional exercise capacity and health-related quality of life (QOL) before surgery. The pre- and postoperative physical fitness, health-related QOL, psychological aspects, and their relationships have not been fully evaluated in patients with esophageal cancer who have undergone esophagectomy
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