Fuchs Hans, Hölscher Arnulf H, Leers Jessica, Bludau Marc, Brinkmann Sebastian, Schröder Wolfgang, Alakus Hakan, Mönig Stefan, Gutschow Christian A
Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
Gastric Cancer. 2016 Jan;19(1):312-7. doi: 10.1007/s10120-015-0466-3. Epub 2015 Jan 28.
Esophagectomy with gastric tube reconstruction and extended transhiatal gastrectomy with Roux-en-Y reconstruction are alternative procedures in current therapeutic concepts for adenocarcinoma of the esophagogastric junction (AEG). The impact of these operations on long-term health-related quality of life (HRQL) is incompletely understood.
Patients with cancer-free survival of at least 24 months after esophagectomy (ESO) or extended gastrectomy (GAST) for AEG were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and cancer-specific (OG-25) quality of life. Numeric scores were calculated for each conceptual area and compared with those of healthy reference populations.
123 patients (ESO n = 71; GAST n = 52) completed the self-rated questionnaires. HRQL was consistently lower in surgical patients (GAST and ESO) compared with healthy reference populations. Also, there was a general trend for a better HRQL in GAST compared with ESO patients. This trend was statistically significant for physical function (p = 0.04), dyspnea (p = 0.02), and reflux (p = 0.03). Subgroup analysis revealed no significant differences between patients with or without prior neoadjuvant therapy.
After mid- and long-term follow-up, HRQL after extended gastrectomy with Roux-en-Y reconstruction is superior to that after esophagectomy and gastric tube reconstruction. Improved HRQL after gastrectomy is mainly due to less pulmonary and reflux-related symptoms. Our findings may influence the choice of the surgical strategy for patients with AEG.
在目前食管胃交界腺癌（AEG）的治疗理念中，食管切除术加胃管重建术以及扩大经裂孔胃切除术加Roux-en-Y重建术是可供选择的手术方式。这些手术对长期健康相关生活质量（HRQL）的影响尚未完全明确。
从一个前瞻性维护的数据库中识别出因AEG接受食管切除术（ESO）或扩大胃切除术（GAST）后无癌生存至少24个月的患者。发放欧洲癌症研究与治疗组织（EORTC）问卷以评估健康相关的总体生活质量（QLQ-C30）和癌症特异性生活质量（OG-25）。计算每个概念领域的数值评分，并与健康对照人群的评分进行比较。
123例患者（ESO组71例；GAST组52例）完成了自评问卷。与健康对照人群相比，手术患者（GAST组和ESO组）的HRQL始终较低。此外，与ESO患者相比，GAST患者的HRQL总体上有更好的趋势。这一趋势在身体功能（p = 0.04）、呼吸困难（p = 0.02）和反流（p = 0.03）方面具有统计学意义。亚组分析显示，接受或未接受新辅助治疗的患者之间无显著差异。
经过中长期随访，Roux-en-Y重建扩大胃切除术后的HRQL优于食管切除加胃管重建术后的HRQL。胃切除术后HRQL的改善主要归因于较少的肺部和反流相关症状。我们的研究结果可能会影响AEG患者手术策略的选择。
