Abstract
BackgroundThe postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. The aim was to evaluate HRQOL outcomes 6 months after extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy.MethodsPatients who underwent surgery for GEJ adenocarcinoma of Siewert type 2 or 3 in 2001–2005 were identified from a nationwide Swedish prospective and population-based cohort. Three surgical strategies, i.e., gastrectomy, esophagectomy, or esophagogastrectomy, were analyzed in relationship to HRQOL measured at 6 months after surgery (main outcome). HRQOL was assessed using well-validated questionnaires for general (EORTC QLQ-C30) and esophageal cancer-specific (EORTC QLQ-OES18) symptoms. Mean score differences (MSD) and 95% confidence intervals (CI) were analyzed using ANCOVA and adjusted for age, sex, tumor stage, comorbidity, education level, hospital volume, and postoperative complications. MSDs > 10 were regarded as clinically relevant.ResultsAmong 176 patients with complete information on HRQOL and covariates, none of the MSDs for HRQOL among the three surgery groups were clinically and statistically significant. MSDs comparing esophagectomy and gastrectomy showed no major differences in global quality of life (MSD, +8, 95% CI, 0 to +16), physical function (MSD, +2, 95% CI, −5 to +9), pain (MSD, −3, 95% CI, −12 to +7), or reflux (MSD, +5, 95% CI, −4 to +14). Also, complication rates and 5-year survival rates were similar comparing esophagectomy and gastrectomy.ConclusionsExtended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.
Highlights
The curative treatment of adenocarcinoma of the gastroesophageal junction (GEJ) typically includes surgical resection
The patients in the gastrectomy group were more likely to have Siewert type III cancer and undergo surgery in a low-volume hospital compared to the esophagectomy group
This study indicates that the choice between gastrectomy, esophagectomy, or esophagogastrectomy has no major influence on the health-related quality of life (HRQOL) for GEJ cancer patients 6 months after surgery
Summary
The curative treatment of adenocarcinoma of the gastroesophageal junction (GEJ) typically includes surgical resection. None of the different surgical alternatives, i.e., total gastrectomy, subtotal esophagectomy, or a combination of these approaches, i.e., esophagogastrectomy, seems to offer superior oncological outcomes [4, 5]. There is a need for larger studies based on unselected patients comparing extended gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy, examining patients with Siewert II and III GEJ cancer. The aim of this study was to elucidate whether any of the three main alternative surgical procedures for GEJ cancer of Siewert II and III has a different impact on postoperative HRQOL at 6 months in a population-based and nationwide Swedish cohort study. The postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. Electronic supplementary material The online version of this article (doi:10.1007/s10120-017-0761-2) contains supplementary material, which is available to authorized users
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