University of Oulu

Kauppila, J., Johar, A., Lagergren, P., Medical and surgical complications and health-related quality of life after esophageal cancer surgery, Annals of Surgery, 2019, Ahead of Print, p. 1-23, ISSN: 0003-4932, DOI: 10.1097/SLA.0000000000003097

Medical and surgical complications and health-related quality of life after esophageal cancer surgery

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Author: Kauppila, Joonas H.1,2,3; Johar, Asif1; Lagergren, Pernilla1,4
Organizations: 1Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
2Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
3Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
4Department of Surgery and Cancer, Imperial College London, London, United Kingdom
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2019110636863
Language: English
Published: Wolters Kluwer, 2019
Publish Date: 2020-10-31
Description:

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.

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Series: Annals of surgery
ISSN: 0003-4932
ISSN-E: 1528-1140
ISSN-L: 0003-4932
Volume: Ahead of print
Issue: Ahead of print
Pages: 1 - 23
DOI: 10.1097/SLA.0000000000003097
OADOI: https://oadoi.org/10.1097/SLA.0000000000003097
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Subjects:
Copyright information: © 2019 Wolters Kluwer Health, Inc. All rights reserved. This is an Accepted Manuscript of an article published in Annals of Surgery. The Definitive Version of Record can be found online at: https://doi.org/10.1097/SLA.0000000000003097.