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Background:

With recent improvements in neoadjuvant therapy and earlier diagnosis, long-term survival after oesophagectomy for adenocarcinoma is becoming more frequent. With longer survival the quality of life (QOL) of patients post resection has thus become a greater priority. There has been extensive debate focusing on the long term effects of different sites for surgical anastomosis. We aimed to examine if long-term post-oesophagectomy QOL is affected by the site of the surgical anastomosis.

Method:

Following local ethics Committee approval QORTC C-30 and OG-25 QOL questionnaires were sent to patients who had survived post-oesophagectomy patients for greater than 3 years. The data was analysed in subsets dependant on the site of oesophago-gastric anastomosis - either thoracic or cervical. No patients in either group underwent formal pyloroplasty. Data was analysed using the student's t-test on SPSS statistical software. QORTC C-30 data was compared against the reference tables for oesophageal cancer pre-treatment.

Results:

A total of 60 patients responded (82%) with a median time post-surgery of 6.1 years (range 3-12 years). Cervical and thoracic anastomosis subgroups were equivalent in terms of age at time of surgery, time post op and cancer stage. No significant QOL difference was noted between cervical or chest anastomosis groups for any functional or symptom score, especially focusing on dysphagia (OG25, p=0.24), odynophagia (OG 25, p=0.68) and swallowing problems (OG25, p=0.73). The patients' overall general health (QL2) score was 72.0±19.43 compared with 71.2±22.4 for the general population (QORTC reference tables). Functional indices and symptom scores are improved for our cohort compared to the QORTC oesophageal cancer reference baseline except symptom scores for diarrhoea and dyspnoea which worsen post-operatively.

Discussion:

There is no significant difference in QOL scores between oesophagectomy patients with cervical or thoracic anastomosis long term post-surgery. QOL in long-term survivors after oesophagectomy compares favourably with QORTC reference data for both pre-treatment oesophageal cancer and baseline general population data in our cohort, possibly due to the absence of pylorplasty. Further prospective QOL data collection is required to elucidate any long-term differences between the two anastomosis sites