University of Oulu

Kauppila, J. H., Johar, A., Gossage, J. A., Davies, A. R., Zylstra, J., Lagergren, J. and Lagergren, P. (2018), Health‐related quality of life after open transhiatal and transthoracic oesophagectomy for cancer. Br J Surg, 105: 230-236. doi:10.1002/bjs.10745

Health-related quality of life after open transhiatal and transthoracic oesophagectomy for cancer

Saved in:
Author: Kauppila, J. H.1,2; Johar, A.1; Gossage, J. A.3,4;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
2Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
3Division of Cancer Studies, King’s College London, London, UK
4Department of Surgery, Guy’s and St Thomas’ Oesophago-Gastric Centre, London, UK
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2018
Publish Date: 2019-11-05


Background: Transhiatal and transthoracic oesophagectomy in patients with oesophageal cancer have similar survival rates. Whether these approaches differ in health‐related quality of life (HRQoL) is uncertain and was examined in this study.

Methods: Patients undergoing transhiatal or transthoracic surgery for lower‐third oesophageal or gastro‐oesophageal junctional cancer between 2011 and 2015 were selected from an institutional database. HRQoL outcomes were measured at 6 and 12 months after surgery using validated written questionnaires (European Organisation for Research and Treatment of Cancer QLQ‐C30 and QLQ‐OG25). Linear mixed models provided mean score differences (MSDs) with 95 per cent confidence intervals, adjusted for preoperative HRQoL, age, physical status (ASA fitness grade), tumour location, tumour stage, neoadjuvant therapy, adjuvant therapy and postoperative complications. MSD values of 10 or more were regarded as clinically relevant.

Results: Some 146 patients underwent transhiatal (86, 58·9 per cent) or transthoracic (60, 41·1 per cent) oesophagectomy. The HRQoL questionnaires were returned by 111 patients at 6 months and 74 at 12 months. At 6 months, transthoracic oesophagectomy was associated with worse role function (MSD −12, 95 per cent c.i. −23 to 0; P = 0·046). At 12 months, patients in the transthoracic group had more nausea and vomiting (MSD 11, 0 to 22; P = 0·045), dyspnoea (MSD 13, 1 to 25; P = 0·029) and constipation (MSD 20, 7 to 33; P = 0·003) than those in the transhiatal group.

Conclusion: Transhiatal oesophagectomy seems to offer better HRQoL than transthoracic oesophagectomy 6 and 12 months after surgery.

see all

Series: British journal of surgery
ISSN: 0007-1323
ISSN-E: 1365-2168
ISSN-L: 0007-1323
Volume: 105
Issue: 3
Pages: 230 - 236
DOI: 10.1002/bjs.10745
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: Funding was provided by Guy’s and St Thomas’ Charity, London, United Kingdom. The study sponsors had no role in the design of the study, data collection, analysis or interpretation of the results, the writing of the manuscript or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.
Copyright information: © 2018 BJS Society Ltd. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Kauppila, J. H., Johar, A. , Gossage, J. A., Davies, A. R., Zylstra, J. , Lagergren, J. and Lagergren, P. (2018), Health‐related quality of life after open transhiatal and transthoracic oesophagectomy for cancer. Br J Surg, 105: 230-236. doi:10.1002/bjs.10745, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.