Abstract

Objective: To evaluate the impact of postoperative medical and surgical complications on health-related quality of life (HRQOL) in esophageal cancer.

Background: Complications after esophageal surgery negatively affect HRQOL, but it is unclear whether medical and surgical complications differ in effects.

Methods: This Swedish population-based, nationwide, and prospective cohort study enrolled 616 patients undergoing esophageal cancer surgery during 2001 to 2005, with 10 years of follow-up. The exposure was the occurrence of the predefined postoperative medical or surgical technical complications. The study outcome was HRQOL, evaluated by European Organisation for Research and Treatment of Cancer questionnaires at 6 months, and 3, 5, and 10 years after surgery. Linear mixed models, adjusted for confounders and complications, provided mean score differences (MDs) and 95% confidence intervals (CIs) for each HRQOL scale and item.

Results: Of the 616 patients, 217 (35%) had medical and 163 (26%) had surgical postoperative complications. In patients with medical complications, HRQOL was generally worse at all time points, with worse global quality of life (QOL) (MD −10, 95% CI −18 to −2) and dyspnea (MD 16, 95% CI 5–27) from 3 years onwards, compared with those without. Patients with surgical complications had worse HRQOL outcomes up to 5 years after surgery, for example, dyspnea at 6 months (MD 11, 95% CI 4–19) and global QOL at 3 years (MD −13, 95% CI −22 to −5), than those without.

Conclusion: Medical complications are associated with long-lasting impairments and worsening HRQOL, whereas the negative effects of surgical complications on HRQOL seem to minimize 5 years postsurgery.