Quality of Life After Endoscopic and Surgical Treatment for Early Neoplasia in Barrett's Esophagus

Abstract

Introduction: Endoscopic treatment (ETx) of early neoplasia in Barrrett's esophagus (BE) is less invasive than surgical treatment (STx) and may therefore preserve quality of life (QOL). On the other hand, ETx requires endoscopic follow-up which may take on a more chronic nature and therefore decrease QOL. Aim: Investigate QOL after ETx or STx for early BE neoplasia, and compare these outcomes with the QOL of an aged-matched healthy Dutch population, using a retrospective cohort design. Patients and Methods: Between 2001 and 2005, 81 patients (pts) had ETx and 33 pts had STx for Early BE Neoplasia. Selection was based on tumour size, depth of penetration (T1m vs. T1 sm), or pts' preference. Twelve to 60 months after treatment, QOL was measured using the SF-36 and disease-specific questionnaires EORTC-QLQ-C30 and EORTC-QLQ-OES18. Analysis: Multivariate analyses with covariates age, gender, histology and co-morbidity, were performed to determine differences in QOL between the ETx group and the STx group for the subscales of the SF-36 and the EORTC-C30 functioning scales. Logistic regression was used for the symptom scales of the EORTC-C30 and the EORTC-OES18. Results: Questionnaires were completed by 91% of the available pts in the ETx group and by 93% of the available pts in the STx group. Both groups were comparable in terms of age (64 vs. 63 years), gender (83% male vs. 82%), and median follow-up after Tx (27.2 mo vs 27.4 mo). The groups differed in terms of length of Tx (ETx 104 ± 92 days vs. STx 28 ± 25; p < 0.001), the rate of cancer (53% vs. 93%; p < 0.001), and the presence of one or more co-morbidities (67% vs. 52%, p < 0.05). Pts with early BE neoplasia treated either endoscopically or surgically reported no differences on the SF-36 compared to an aged-matched healthy Dutch population. Multivariate analysis of the SF-36 showed no significant differences between the ETx and STx groups in any of the SF-36 subscales. EORTC-C30 functioning and symptoms scales also showed no significant differences between the two treatment groups. On the EORTC-OES18, the STx group reported more eating problems (OR = 18.3, p < 0.001), more reflux symptoms (OR = 3.4, p = 0.045), and more trouble with speaking (OR = 5.1, p = 0.094) than the ETx group. Conclusion: The overall QOL of pts with early BE neoplasia, 1 to5 years after STx or ETx is comparable and does not differ significantly from that of an aged-matched healthy Dutch population. After STx, pts report more disease related symptoms than after ETx.