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Quality of Life After Transhiatal Compared With Extended Transthoracic Resection for Adenocarcinoma of the Esophagus

From the Departments of Medical Psychology and Surgery, Academic Medical Center, Amsterdam; and Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands

Address reprint requests to A.G.E.M. de Boer, MD, Coronel Institute, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, the Netherlands; e-mail: A.G.deBoer{at}amc.uva.nl

PURPOSE: To assess 3 years of quality of life in patients with esophageal cancer in a randomized trial comparing limited transhiatal resection with extended transthoracic resection.

PATIENTS AND METHODS: Quality-of-life questionnaires were sent at baseline and at 5 weeks; 3, 6, 9, and 12 months; and 1.5, 2, 2.5, and 3 years after surgery. Physical and psychological symptoms, activity level, and global quality of life were assessed with the disease-specific Rotterdam Symptom Checklist. Generic quality of life was measured with the Medical Outcomes Study Short Form-20.

RESULTS: A total of 199 patients participated. Physical symptoms and activity level declined after the operation and gradually returned toward baseline within the first year (P < .01). Psychological well-being consistently improved after baseline (P < .01), whereas global quality of life showed a small initial decline followed by continuous gradual improvement (P < .01). Quality of life stabilized in the second and third year. Three months after the operation, patients in the transhiatal esophagectomy group (n = 96) reported fewer physical symptoms (P = .01) and better activity levels (P < .01) than patients in the transthoracic group (n = 103), but no differences were found at any other measurement point. For psychological symptoms and global quality of life, no differences were found at any follow-up measurement. A similar pattern was found for generic quality of life.

CONCLUSION: No lasting differences in quality of life of patients who underwent either transhiatal or transthoracic resection were found. Compared with baseline, quality of life declined after the operation but was restored within a year in both groups.

This study was supported by grant No. 1996-041 from the Dutch Health Care Insurance Funds Council.

Clinical data of this study have been published previously in Hulscher JBF, van Sandick JW, de Boer AGEM, et al: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662-1669, 2002.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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