Surgical Care Science, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Department of Surgery & Cancer, Imperial College London, London, UK.
J Cancer Surviv. 2021 Dec;15(6):818-824. doi: 10.1007/s11764-020-00974-9. Epub 2021 Jan 27.
Esophagectomy for cancer is an extensive procedure often followed by severe complications. This study investigated whether patients with severe symptoms of reflux are more likely to have sleep disturbances and reduced health-related quality of life (HRQL) after esophagectomy.
This Swedish nationwide prospective cohort study encompassed all patients who had undergone esophagectomy for cancer between 2013 and 2018. One year after surgery, the patients responded to three questionnaires on reflux (EORTC QLQOG25), sleep disturbances (KSQ), and HRQL (EORTC QLQ-C30). Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI) for sleep disturbance/reduced HRQL between patients with and without reflux, adjusted for potential confounders.
Among 241 esophagectomy patients, 66 (27%) reported severe reflux. Patients with reflux had an increased risk of sleep disturbances (OR 2.3, 95% CI: 1.3-4.3) compared to patients without reflux. More specifically, these patients were more likely to suffer from poor sleep quality (OR 4.9, 95% CI: 1.9-12.4). Patients with reflux and sleep disturbances reported reductions in global quality of life, role function, emotional function, social function, and more symptoms in all scales, except for dyspnea.
This study suggests that patients with severe symptoms of reflux after esophagectomy have an increased risk of sleep disturbances and poor sleep quality, which in turn are associated with reduced HRQL.
Alleviating reflux after oesophageal cancer surgery is important, since this common symptom might reduce HRQL and well-being.
食管癌切除术是一种广泛的手术，常伴有严重的并发症。本研究旨在探讨患有严重反流症状的患者在食管癌切除术后是否更有可能出现睡眠障碍和健康相关生活质量（HRQL）下降。
本研究为瑞典全国性前瞻性队列研究，纳入了 2013 年至 2018 年间接受食管癌切除术的所有患者。术后 1 年，患者对反流（EORTC QLQOG25）、睡眠障碍（KSQ）和 HRQL（EORTC QLQ-C30）三个问卷进行了回复。多变量逻辑回归提供了有反流和无反流患者之间睡眠障碍/HRQL 降低的比值比（OR）及其 95%置信区间（CI），调整了潜在混杂因素。
在 241 例食管癌切除术患者中，66 例（27%）报告有严重反流。与无反流患者相比，有反流的患者发生睡眠障碍的风险增加（OR 2.3，95%CI：1.3-4.3）。具体而言，这些患者更有可能出现睡眠质量差（OR 4.9，95%CI：1.9-12.4）。有反流和睡眠障碍的患者报告全球健康状况、角色功能、情绪功能、社会功能等所有量表的评分降低，除呼吸困难量表外。
本研究表明，食管癌切除术后有严重反流症状的患者发生睡眠障碍和睡眠质量差的风险增加，这反过来又与 HRQL 下降有关。
缓解食管癌手术后的反流症状很重要，因为这种常见的症状可能会降低 HRQL 和幸福感。
