Introduction With improvements in neoadjuvant therapy and earlier diagnosis, long-term survival after oesophagectomy for adenocarcinoma is becoming more frequent. With longer survival the quality of life (QOL) of patients post resection has become a greater priority. There has been extensive debate focusing on the long term effects of different sites for anastomosis. We aimed to examine if post-oesophagectomy QOL is affected by the site of the surgical anastomosis.
Methods QORTC C-30 and OG-25 QOL questionnaires were analysed from post-oesophagectomy patients surviving >3 years. Data were available both from a prospective database and questionnaires sent to post-oesophagectomy patients. Surgery was completed by two surgical teams and data were analysed in subsets dependant on the site of oesophago-gastric anastomosis—either thoracic or cervical. No patients underwent formal pyloroplasty. Data were analysed using the Student t test on SPSS statistical software. QORTC C-30 data were compared against the reference tables for oesophageal cancer pre-treatment and a cohort of pre-surgical patients awaiting oesophagectomy. Ethical approval was granted by the local MREC.
Results A total of 60 patients responded (82%, anastomosis: thoracic n=29, cervical n=31) with a median time post-surgery of 6.1 years (range 3–12 years). Cervical and thoracic anastomosis subgroups were equivalent in terms of age at time of surgery, time post op and cancer stage. No significant QOL difference was noted between cervical or chest anastomosis groups for any functional or symptom score, especially focusing on dysphagia (OG25, p=0.24), odynophagia (OG 25, p=0.68) and swallowing problems (OG25, p=0.73). The patients' overall general health (QL2) score was 72.0±19.43 (mean±SD) compared with 74.8±20.57 for a cohort of 53 NNUH pre-op oesophagectomy patients and 71.2±22.4 for the QORTC general population reference data. Functional indices and symptom scores are improved for our cohort compared to the QORTC oesophageal cancer reference baseline except symptom scores for diarrhoea and dyspnoea which worsen post-operatively.
Conclusion There is no significant difference in QOL scores between oesophagectomy patients with cervical or thoracic anastomosis at >3 years post-surgery when analysed using the QORTC C-30 and OG25 questionnaires. QOL in long-term survivors after oesophagectomy compares favourably with QORTC reference data for both pre-treatment oesophageal cancer and baseline general population data in our cohort, possibly due to the absence of pylorplasty. Further prospective QOL data collection is required to elucidate any long-term differences between the two anastomosis sites.
Competing interests None declared.
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