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Impact of the Site of Anastomosis after Oncologic Esophagectomy on Quality of Life — A Prospective, Longitudinal Outcome Study

¹ Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Germany
² Reference Center for Quality of Life, University Hospital Schleswig-Holstein, Kiel, Germany
³ Department of Dermatology and Dermato-Oncology, University Hospital Schleswig-Holstein, Kiel, Germany

Correspondence: Address correspondence and reprint requests to: Jan-Hendrik Egberts, MD; E-mail: jegberts{at}chirurgie-sh.de

Background: For patients undergoing oncologic surgery, the quality of life (QoL) is generally accepted as an important outcome parameter in addition to long-term survival, mortality, and complication rates. Our study focused on outcome in terms of QoL in patients with esophageal cancer, comparing the sites of anastomosis (cervical versus thoracic anastomosis).

Methods: In a prospective longitudinal single-center study from 1998 to 2005, 105 patients underwent surgery for esophageal cancer. To assess QoL the EORTC-QLQ-C-30 and a tumor-specific module were administered before surgery, at discharge, and three, six, 12, and 24 months after surgery. Clinical data were collected prospectively and follow-up was performed every six months.

Results: The histological type was squamous cell carcinoma in 51.4% of the cases, adenocarcinoma in 41.9%, and some other type in 6.7%. There was no significant difference between cervical and thoracic anastomosis with regard to morbidity, mortality, and survival rates (30% five-year survival rate), whereas tumor stage was a significant (p < 0.001) prognostic factor. Most QoL scores dropped significantly below baseline in the early postoperative period. Even though they recovered slowly during the follow-up period, they never reached preoperative levels again. There was no statistically significant difference in any of the QoL scales between patients with a cervical or a thoracic anastomosis.

Conclusions: Esophageal resections are associated with significant deterioration of QoL, which persists during the follow-up period. The surgical technique and position of the esophagogastrostomy did not affect QoL deterioration.

Key Words: Esophageal cancer • Quality of life • Esophagogastrostomy • Esophagectomy • Anastomosis