Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Ann Surg Oncol. 2022 May;29(5):2842-2851. doi: 10.1245/s10434-021-11049-z. Epub 2021 Nov 23.
The impact of postoperative complications on cancer-related fatigue is unknown. This nationwide prospective cohort study aimed to assess the trajectory of cancer-related fatigue and the influence of predefined postoperative complications on cancer-related fatigue up to 2 years after esophageal cancer surgery.
The patients in this study underwent esophagectomy between 2013 and 2019 in Sweden. The exposure was predefined postoperative complications. The outcome was cancer-related fatigue measured by the fatigue scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the EORTC QLQ-Fatigue 12 (QLQ-FA12) questionnaire. Linear mixed-effects models provided adjusted fatigue scores and mean score differences (MDs) with 95% confidence intervals (CIs) between patients with and without predefined complications.
The study enrolled 331 patients. The QLQ-C30 fatigue score increased with clinical relevance among patients with any complications (MD, 5.8; 95% CI, 2.6-9.0) who had a higher Clavien-Dindo classification (grades 2 to 3a: MD, 7.3; 95% CI, 3.1-11.5), a medical complication (MD, 6.9; 95% CI, 3.0-10.7), or a pulmonary complication (MD, 6.9; 95% CI, 2.1-11.6) for 1-1.5 years and remained stable until 2 years after esophagectomy. Similar patterns were found in the QLQ-FA12 fatigue and QLQ-FA12 physical and emotional subscales, but not in the cognitive subscales.
Complications in general and medical and pulmonary complications in particular might be associated with increased cancer-related fatigue after esophagectomy.
术后并发症对癌症相关疲劳的影响尚不清楚。本项全国性前瞻性队列研究旨在评估食管癌手术后 2 年内癌症相关疲劳的轨迹，以及预先设定的术后并发症对癌症相关疲劳的影响。
本研究中的患者于 2013 年至 2019 年在瑞典接受了食管癌切除术。暴露因素为预先设定的术后并发症。结局为欧洲癌症研究与治疗组织生活质量核心问卷 30 版（EORTC QLQ-C30）和 EORTC 疲劳量表 12 版（QLQ-FA12）问卷测量的癌症相关疲劳。线性混合效应模型提供了调整后的疲劳评分和平均值差异（MD），95%置信区间（CI）为有和无预先设定并发症的患者之间的差异。
本研究纳入了 331 例患者。在有任何并发症的患者中（MD，5.8；95%CI，2.6-9.0），QLQ-C30 疲劳评分随临床相关性而增加，且患者的 Clavien-Dindo 分级（2-3a 级：MD，7.3；95%CI，3.1-11.5）较高、发生了医疗并发症（MD，6.9；95%CI，3.0-10.7）或肺部并发症（MD，6.9；95%CI，2.1-11.6），这种情况在术后 1-1.5 年时更为明显，直到食管癌手术后 2 年时仍保持稳定。QLQ-FA12 疲劳、QLQ-FA12 身体和情绪子量表中也存在类似的模式，但认知子量表中没有。
一般来说，并发症，尤其是医疗和肺部并发症，可能与食管癌手术后癌症相关疲劳的增加有关。
