Svetanoff Wendy Jo, McGahan Rose, Singhal Saurabh, Bertellotti Carrie, Mittal Sumeet K
Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA.
Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA.
Patient Relat Outcome Meas. 2018 Apr 4;9:137-146. doi: 10.2147/PROM.S150180. eCollection 2018.
Esophageal resection is the primary treatment for malignant esophageal disease and the last resort for benign end-stage esophageal disease. There is a paucity of research comparing the long-term quality of life (QoL) following surgery among these two populations. The aim of this study was to examine the patient reported QoL after esophageal resection using questionnaires focusing on general well-being and esophageal-specific symptoms.
A prospectively maintained database of post-operatively administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) with supplemental esophageal cancer-specific questionnaires (OES-18) was queried after institutional review board approval through Creighton University School of Medicine. Inclusions were made if patients received an esophageal resection for benign or malignant esophageal disease. Emergency procedures, delayed reconstructions, and stage IV disease were excluded. Student's -test was used for domains of function, symptoms, QoL, and esophageal-specific complaints to compare the groups with each other and with the general population.
A total of 39 out of 248 patients with malignant disease and 24 out of 46 with benign disease completed the questionnaire. A mean post-operative follow-up of 53 months with a response rate of 40% was obtained. There was no difference in physical (=0.81), role ( =0.37), conditional (=0.73), emotional (=0.06), or social functions (=0.42) between the general population and the esophageal resection groups. There was also no significant difference in generalized pain (=0.86), nausea/vomiting (=0.27), fatigue (=0.86), swallowing (=0.35), or esophageal pain (=0.12). The malignant cohort had better outcomes than the benign cohort with respect to eating (=0.04), indigestion (=0.04), and QoL (=<0.01).
The underlying disease between these cohorts is drastically different, but postoperative functional status, generalized symptoms, swallowing ability, and esophageal pain were similar. There was no difference in functional status between the general population and the esophageal resection cohorts. Patients with malignant disease reported less problems with eating and a better QoL than their benign counterparts.
食管切除术是恶性食管疾病的主要治疗方法，也是良性终末期食管疾病的最后治疗手段。目前比较这两类人群术后长期生活质量（QoL）的研究较少。本研究的目的是使用关注总体健康状况和食管特异性症状的问卷，调查食管切除术后患者报告的生活质量。
经机构审查委员会批准，通过克里顿大学医学院查询前瞻性维护的术后管理的欧洲癌症研究与治疗组织生活质量问卷C30（EORTC QLQ-C30）及补充食管癌特异性问卷（OES-18）的数据库。纳入标准为接受良性或恶性食管疾病食管切除术的患者。排除急诊手术、延迟重建和IV期疾病患者。采用学生t检验对功能、症状、生活质量和食管特异性主诉等领域进行比较，以比较两组之间以及与一般人群的差异。
248例恶性疾病患者中有39例、46例良性疾病患者中有24例完成了问卷。术后平均随访53个月，回复率为40%。一般人群与食管切除组在身体功能（=0.81）、角色功能（=0.37）、条件功能（=0.）、情感功能（=0.06）或社会功能（=0.42）方面无差异。在全身疼痛（=0.86）、恶心/呕吐（=0.27）、疲劳（=0.86）、吞咽（=0.35）或食管疼痛（=0.12）方面也无显著差异。在进食（=0.04）、消化不良（=0.04）和生活质量（=<0.01）方面，恶性队列的结果优于良性队列。
这些队列中的基础疾病差异很大，但术后功能状态、全身症状、吞咽能力和食管疼痛相似。一般人群与食管切除队列的功能状态无差异。恶性疾病患者报告的进食问题比良性疾病患者少，生活质量也更好。
