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      Health-related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma

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          Abstract

          Background

          The 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.

          Methods

          Patients 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.

          Results

          Among 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.

          Conclusions

          Extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.

          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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          Most cited references25

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          Classification of adenocarcinoma of the oesophagogastric junction.

          J Siewert, H Stein (1998)
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            Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients.

            J Siewert, Marcus Feith, M. Werner … (2000)
            To assess the outcome of surgical therapy based on a topographic/anatomical classification of adenocarcinoma of the esophagogastric junction. Because of its borderline location between the stomach and esophagus, the choice of surgical strategy for patients with adenocarcinoma of the esophagogastric junction is controversial. In a large single-center series of 1,002 consecutive patients with adenocarcinoma of the esophagogastric junction, the choice of surgical approach was based on the location of the tumor center or tumor mass. Treatment of choice was esophagectomy for type I tumors (adenocarcinoma of the distal esophagus) and extended gastrectomy for type II tumors (true carcinoma of the cardia) and type III tumors (subcardial gastric cancer infiltrating the distal esophagus). Demographic data, morphologic and histopathologic tumor characteristics, and long-term survival rates were compared among the three tumor types, focusing on the pattern of lymphatic spread, the outcome of surgery, and prognostic factors in patients with type II tumors. There were marked differences in sex distribution, associated intestinal metaplasia in the esophagus, tumor grading, tumor growth pattern, and stage distribution between the three tumor types. The postoperative death rate was higher after esophagectomy than extended total gastrectomy. On multivariate analysis, a complete tumor resection (R0 resection) and the lymph node status (pN0) were the dominating independent prognostic factors for the entire patient population and in the three tumor types, irrespective of the surgical approach. In patients with type II tumors, the pattern of lymphatic spread was primarily directed toward the paracardial, lesser curvature, and left gastric artery nodes; esophagectomy offered no survival benefit over extended gastrectomy in these patients. The classification of adenocarcinomas of the esophagogastric junction into type I, II, and III tumors shows marked differences between the tumor types and provides a useful tool for selecting the surgical approach. For patients with type II tumors, esophagectomy offers no advantage over extended gastrectomy if a complete tumor resection can be achieved.
            Article 0 comments Cited 105 times – based on 0 reviews     Review now
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              Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer.

              J.M. Blazeby, T Conroy, E Hammerlid … (2003)
              Quality of life (QOL) assessment requires clinically relevant questionnaires that yield accurate data. This study defined measurement properties and the clinical validity of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to assess QOL in oesophageal cancer. The oesophageal module the QLQ-OES24 and core questionnaire, the Quality of Life-Core 30 questionnaire (QLQ-C30) was administered patients undergoing treatment with curative (n=267) or palliative intent (n=224) and second assessments performed 3 months or 3 weeks later respectively. Psychometric tests examined scales and measurement properties of the module. Questionnaires were well accepted, compliance rates were high and less than 2% of items had missing data. Multi-trait scaling analyses and face validity refined the module to four scales and six single items (QLQ-OES18). Selective scales distinguished between clinically distinct groups of patients and demonstrated treatment-induced changes over time. The EORTC QLQ-OES18 demonstrates good psychometric and clinical validity. It is recommended for use with the core questionnaire, the QLQ-C30, to assess QOL in patients with oesophageal cancer.
              Article 0 comments Cited 97 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Joonas H. Kauppila: +46 8-517 709 83 , joonas.kauppila@ki.se
                Journal
                Journal ID (nlm-ta): Gastric Cancer
                Journal ID (iso-abbrev): Gastric Cancer
                Title: Gastric Cancer
                Publisher: Springer Japan (Tokyo )
                ISSN (Print): 1436-3291
                ISSN (Electronic): 1436-3305
                Publication date (Electronic): 29 August 2017
                Publication date PMC-release: 29 August 2017
                Publication date (Print): 2018
                Volume: 21
                Issue: 3
                Pages: 533-541
                Affiliations
                [1 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, , Karolinska University Hospital, ; 17176 Stockholm, Sweden
                [2 ]Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
                [3 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, , Karolinska University Hospital, ; 17176 Stockholm, Sweden
                [4 ]GRID grid.420545.2, Division of Cancer Studies, , King’s College London and Guy’s and St. Thomas’ NHS Foundation Trust, ; London, England, UK
                Article
                Publisher ID: 761
                DOI: 10.1007/s10120-017-0761-2
                PMC ID: 5906505
                PubMed ID: 28852939
                SO-VID: b8971b07-f9e0-4ef8-a6f2-44df9efa8623
                Copyright © © The Author(s) 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 24 May 2017
                Date accepted : 16 August 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Funded by: FundRef http://dx.doi.org/10.13039/501100007232, Radiumhemmets Forskningsfonder;
                Funded by: FundRef http://dx.doi.org/10.13039/501100002794, Cancerfonden;
                Funded by: FundRef http://dx.doi.org/10.13039/501100007083, Orionin Tutkimussäätiö;
                Funded by: FundRef http://dx.doi.org/10.13039/501100006306, Sigrid Juséliuksen Säätiö;
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: esophageal neoplasm,gastric cancer,surgery,symptoms,functions
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: esophageal neoplasm, gastric cancer, surgery, symptoms, functions

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