Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden.
Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
Gastric Cancer. 2018 May;21(3):533-541. doi: 10.1007/s10120-017-0761-2. Epub 2017 Aug 29.
The postoperative health-related quality of life (HRQOL) outcomes in patients with gastroesophageal junction (GEJ) adenocarcinoma after gastrectomy and esophagectomy are unclear. The aim was to evaluate HRQOL outcomes 6 months after extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy.
Patients who underwent surgery for GEJ adenocarcinoma of Siewert type 2 or 3 in 2001-2005 were identified from a nationwide Swedish prospective and population-based cohort. Three surgical strategies, i.e., gastrectomy, esophagectomy, or esophagogastrectomy, were analyzed in relationship to HRQOL measured at 6 months after surgery (main outcome). HRQOL was assessed using well-validated questionnaires for general (EORTC QLQ-C30) and esophageal cancer-specific (EORTC QLQ-OES18) symptoms. Mean score differences (MSD) and 95% confidence intervals (CI) were analyzed using ANCOVA and adjusted for age, sex, tumor stage, comorbidity, education level, hospital volume, and postoperative complications. MSDs > 10 were regarded as clinically relevant.
Among 176 patients with complete information on HRQOL and covariates, none of the MSDs for HRQOL among the three surgery groups were clinically and statistically significant. MSDs comparing esophagectomy and gastrectomy showed no major differences in global quality of life (MSD, +8, 95% CI, 0 to +16), physical function (MSD, +2, 95% CI, -5 to +9), pain (MSD, -3, 95% CI, -12 to +7), or reflux (MSD, +5, 95% CI, -4 to +14). Also, complication rates and 5-year survival rates were similar comparing esophagectomy and gastrectomy.
Extended total gastrectomy, subtotal esophagectomy, and combined esophagogastrectomy seemed to yield similar 6-month postoperative HRQOL outcomes for patients with GEJ adenocarcinoma.
胃食管结合部（GEJ）腺癌患者行胃切除术和食管切除术的术后健康相关生活质量（HRQOL）结果尚不清楚。本研究旨在评估 Siewert 2 型或 3 型 GEJ 腺癌患者行扩大全胃切除术、次全食管切除术和联合食管胃切除术 6 个月后的 HRQOL 结果。
从 2001-2005 年瑞典全国前瞻性和基于人群的队列中确定了接受 Siewert 2 型或 3 型 GEJ 腺癌手术的患者。分析了 3 种手术策略（胃切除术、食管切除术或食管胃切除术）与术后 6 个月 HRQOL 的关系（主要结局）。使用经过充分验证的一般（EORTC QLQ-C30）和食管癌特异性（EORTC QLQ-OES18）症状问卷评估 HRQOL。采用 ANCOVA 分析平均得分差异（MSD）和 95%置信区间（CI），并调整年龄、性别、肿瘤分期、合并症、教育程度、医院容量和术后并发症。MSD>10 被认为具有临床意义。
在 176 例 HRQOL 信息和协变量完整的患者中，3 组手术的 HRQOL MSD 均无统计学意义。与胃切除术相比，食管切除术的全球生活质量（MSD，+8，95%CI，0 至+16）、躯体功能（MSD，+2，95%CI，-5 至+9）、疼痛（MSD，-3，95%CI，-12 至+7）和反流（MSD，+5，95%CI，-4 至+14）的 MSD 无显著差异。此外，食管切除术和胃切除术的并发症发生率和 5 年生存率相似。
对于 Siewert 2 型或 3 型 GEJ 腺癌患者，行扩大全胃切除术、次全食管切除术和联合食管胃切除术似乎可获得相似的术后 6 个月 HRQOL 结果。
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