Abstract
AimCompared to open esophagectomy (OE), both totally minimally invasive (TMIE) and laparoscopy-assisted hybrid minimally invasive (HMIE) reduce postoperative morbidity and improve short-term health-related quality of life (HRQoL). We aimed to compare lasting symptoms and long-term HRQoL in an international population-based setting between patients who underwent Ivor Lewis TMIE, HMIE or OE. MethodsPatients who were relapse-free at least one year after TMIE, HMIE or OE for esophageal or junctional carcinoma between January 2010 and June 2016 were included. Patients completed the LASER questionnaire to assess lasting symptoms after esophagectomy and the EORTC QLQ-C30 and QLQ-OG25 questionnaires to assess HRQoL. Primary endpoint was chest pain and secondary endpoints were pain from chest scars or abdominal scars, abdominal pain, fatigue and physical functioning. Differences in lasting symptoms and HRQoL were assessed with multivariable logistic and ANCOVA regression, respectively. ResultsA total of 362 patients were included (TMIE n = 91, HMIE n = 85, OE n = 186). Median follow-up was 3.9 years (IQR 2.8–5.4). Chest pain was reported less after TMIE compared with HMIE (adjusted OR 0.21, 95% CI 0.05–0.84), but was comparable between TMIE and OE (adjusted OR 0.41, 95% CI 0.12–1.41) and between HMIE and OE (adjusted OR 1.85, 95% CI 0.71–4.81). All secondary endpoints were comparable between TMIE, HMIE and OE. The impact of symptoms on taking medication, return to work, and performance status were comparable between groups. ConclusionSurgical technique seems to have little effect on lasting symptoms and long-term HRQoL after a median of four years after Ivor Lewis esophagectomy.
Highlights
91 patients were included in the totally minimally invasive (TMIE) group, 85 patients in the hybrid minimally invasive (HMIE) group, and 186 in the Open esophagectomy (OE) group
Besides health-related quality of life (HRQoL), we focused on lasting symptoms
The present study suggests that surgical technique has little effect on lasting symptoms and long-term HRQoL in patients who underwent Ivor Lewis esophagectomy and are alive and relapsefree after a median of four years after surgery
Summary
Esophagectomy is the cornerstone of treatment for patients with esophageal cancer. One of the most common surgical approaches and the preferred approach for tumors located in the middle or distal esophagus is an Ivor Lewis esophagectomy (i.e. transthoracic esophagectomy with intrathoracic anastomosis). Open esophagectomy (OE), is associated with relatively high postoperative morbidity and mortality, lasting symptoms in two thirds of patients and decreased long-term health-related quality of life (HRQoL) [1e3]. In order to minimize postoperative morbidity and improve HRQoL, especially of transthoracic esophagectomy, minimally invasive approaches have been introduced B.J. van der Wilk et al, Lasting symptoms and long-term health-related quality of life after totally minimally invasive, hybrid and open Ivor Lewis esophagectomy, European Journal of Surgical Oncology, https://doi.org/10.1016/ j.ejso.2021.10.023
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