Carcinoma esophagus is a disease with dismal prognosis and even though treatment has evolved considerably, morbidity after surgery has remained a drawback. We intend to prospectively study the pattern of care for such patients at our centre, how it affects their subsequent quality of life (QoL) and the factors that influence these changes.
All patients who underwent curative esophagectomy for carcinoma esophagus from May,2017 to May,2019 were included in the study after obtaining informed consent. Patient characteristics, pre-op therapy, surgical details and final histopathology reports were collected. QoL was collected at pre-op, 1 and 6 months after surgery using FACT-E, OES 18 and OG 25 questionnaires. QoL analysis was done comparing the changes that occured after curative surgery with the baseline value.
99 patients underwent curative esophagectomy during the study period. With a mean age of 58.8 and a male to female ratio of 3.54 : 1, 84/99 underwent surgery after NACT. Lower third and GE junction primary adenocarcinomas accounted for 72 % of cases. Totally minimally invasive McKeowns procedure was the most common surgery done (33%). 8 patients comprised the 30-day mortality with 5 patients having anastomotic leak. QoL analysis showed a dip in post-op QoL at 1 month, with improvement to baseline at 6 months, both in general functional scales, as well as symptom scales. The improvement in symptom scales assessed by OES 18 and OG 25 were found to be statistically significant ( p value < 0.05). Younger patients (<50 yrs) and females fared better during the post-op period. There was a trend to better QoL for patients who underwent minimally invasive procedures. Those patients who had post-op complications, had inferior QoL at 1 month, but later improved by 6 months.
Radical esophagectomy can be performed with achievable morbidity and mortality at high volume centres. Global HRQoL scores show a dip during immediate post-surgery period, but then picks up to even eclipse pre-op values. Post-op morbidity, as expected, adversely affects HRQoL, but once patients tide over the immediate period, they often do well as time passes.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.