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Complications after esophageal cancer surgery lead to long-term health issues
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The occurrence of postoperative complications after surgery for esophageal cancer had significant and long-term effects on health-related quality of life in patients who were alive 5 years after surgery, according to the results of a Swedish study.
Although prior research had established the effect of postoperative complications on health-related quality of life, little was known about long-term effects.
The study included 141 patients who were assessed longitudinally until 5 years post-surgery using the EORTC Quality of Life Questionnaire C30 and OES18. Most patients in the study were aged 60 years or older and had at least one comorbidity. Of the studied patients, 33% experienced a major postoperative complication.
Patients with at least one major postoperative complication reported significantly more dyspnea and fatigue compared with those who did not have complications. When looking at esophageal-related symptoms, patients with postoperative complications also had significantly more eating restriction.
Patients also reported problems with choking; however, these levels eventually declined to that of the general population. In contrast, problems with gastroesophageal reflux and sleep difficulties progressively worsened during the 5-year follow-up.
“The results of this study emphasize the need to adopt strategies to avoid post-operative complications,” the researchers wrote. “Furthermore, patients who have experienced major postoperative complication should be actively screened for these symptoms at routine follow-ups and offered rehabilitation.”
Perspective
Back to TopDavid H. Ilson, MD, PhD
Twenty-five percent to 35% of patients undergoing esophagectomy achieve long-term survival after treatment for esophageal cancer. However, there are limited data regarding the quality of life in long-term survivors. Derogar and colleagues report that long-term survivors after esophagectomy may continue to have compromise in quality of life — including symptoms of choking, odynophagia and reflux — in particular if there were associated postoperative complications after esophagectomy.
Despite the persistent risk of long-term swallowing and eating issues after esophagectomy, for adenocarcinoma of the esophagus surgery remains a requisite part of treatment in the majority of patients even after combined modality chemoradiotherapy. This is due to the relatively low rate of pathologic complete response — generally less than 20% to 30% — to chemoradiotherapy alone without surgery. Some argue to observe patients after a clinical complete response to chemoradiotherapy and perform surgery only in patients with local recurrence or persistence of disease.
However, a delay in surgery up to 6 months beyond completion of chemoradiotherapy may actually lead to an increase in postoperative complications. As we have learned from the current report, more postoperative complications may lead to a more adverse quality of life in long-term survivors after esophagectomy. Beyond surgery, there is no current method to identify patients with a pathologic complete response to chemoradiotherapy who may be spared surgery. Research is ongoing to identify more active predictive markers of complete response.
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