Influence of Surgery‐related Factors on Quality of Life after Esophageal or Cardia Cancer Resection

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Abstract
Knowledge of how factors related to esophageal cancer resection affect long-term quality of life after surgery is scarce, and no population-based studies are available. Therefore, we conducted a Swedish nationwide, prospective, population-based study of how esophageal surgery–related factors influence quality of life 6 months postoperatively. The Swedish Esophageal and Cardia Cancer register (SECC-register) encompasses 174 hospital departments (97%). Microscopically radically operated patients responded to a validated written questionnaire assessing quality of life. The basic questionnaire (QLQ-C30) and the esophagus-specific module (OES-24) were developed by the European Organization for Research and Treatment of Cancer. The Mann-Whitney test, the Jonckheere-Terpstras test, and logistic regression were used in statistical analyses. Among 100 included patients, the occurrence of surgery-related complications was the main predictor of reduced global quality of life 6 months after surgery (p for trend = 0.03). This effect remained after adjustment for potential confounding variables. Except for anastomotic strictures, each of the predefined complications—i.e., anastomotic leakage, infections, cardiopulmonary complications, and operative technical complications—contributed to decreased quality-of-life scores. Other potentially relevant factors—e.g. degree of lymph node dissection, resection margins, operative blood loss or duration, and hospital type—did not significantly affect quality of life. In conclusion, any measures that can reduce the risk of major surgery–related complications can decrease the negative impact on quality of life after esophageal cancer surgery. More population-based studies are warranted, however.