| Part Ⅰ Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via minimally invasive surgery or open surgeryObjective:For patients with esophageal cancer, radical surgical resection of the esophagus and surrounding lymph nodes is the only curative treatment option. The conventional open esophagectomy has the disadvantage of extensive trauma and slow recovery. Recently, minimally invasive surgery has been applied in esophagectomy, and it appears to have better outcome preliminarily. In this study, we compared the short-term quality of life (QOL) in patients with esophageal cancer after subtotal esophagectomy via minimally invasive surgery or open surgery.Method:A total of56patients who underwent three-incision esophagectomy by the same surgical group from January2007to February2008were enrolled in this retrospective study. Twenty-seven patients followed minimally invasive esophagectomy (MIE group) and29patients followed open surgery (open group). The EORTC core questionnaire (QLQ C-30) together with esophageal-specific module (OES-18) were applied to assess the short-term QOL of the patients before and2,4,16,24weeks after operationResult:All of the global quality scale, functioning scale, general symptom scales did not show differences before operation between the two groups. However, the scores of global quality and physical functioning were decreased rapidly after operation, and the scores becomes recovering during the post-operation two weeks in MIE group, about reach to the level of before operation. However, such condition shappen in open group are post-operation four weeks and twenty-four weeks, respectively. Besides, the scores of fatigue, pain, dyspnea were deteriorated after operation, especially in post-operation two weeks. The open group are worsen than the MIE group in the early time. The scores of fatigue and pain are recover to the beginning one, nevertheless, the score of dyspnea in open group still lower than those of MIE group.Conclusions MIE shows an overall benefit on QOL for the patients with esophageal cancer during the follow-up of six month after esophagectomy, compared with open surgery.Part Ⅱ Comparison of the short-term quality of life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomyObjective:To compare the short-term quality of life (QOL) between the two different routes of gastric tube reconstruction after minimally invasive esophagectomy(MIE).Method:From January2007to June2009,97patients who underwent three-incision subtotal MIE were enrolled in this retrospective study. Among them,49patients followed prevertebral route and48patients followed retrosternal route. The questionnaires (EORTC QLQ C-30andOES-18) were applied to assess the QOL of the patients before and2,4,12,24weeks after operation.Result:All the patients underwent operation with no mortality. No statistical difference was found in age, gender, serum albumin level, the level of growth in the esophagus, pathological diagnosis, tumor stage, operation time, blood loss or ICU stay between the two groups. The perioperative complication rate was35.4%in retrosternal group and32.7%in prevertebral group (P=0.774). However, the rate of cervical anastomotic leak in the retrosternal group was much higher (20.8vs.6.1%, P=0.033). But the rate of cardiac or pulmonary complication in the retrosternal group seemed to be lower (10.4vs.22.4%, P=0.110). Besides, the rate of anastomotic stricture was similar (6.3vs.10.2%, P 0.735). And all QOL measures did not show major differences between the two groups before operation. However, at the time of2weeks after operation, the dysphagia and eating problem questionnaires scores were higher in retrosternal group than in prevertebral group, which meant that the patients in retrosternal group suffered more severe problems; meanwhile, the scores of global quality scale in retrosternal group was also lower, which indicated that the patients had a worse global quality of life. Whereas, at the time of12and24weeks after operation, the dyspnea and reflux symptom questionnaire scores were lower in retrosternal group than in prevertebral group, which revealed that there were less problems in the patients of retrosternal group; meanwhile, the score of global quality scale in retrosternal group was higher conversely, which suggested that the patients gain a better status in global quality of life.Conclusion:Our results suggest that retrosternal route may be a good alternative choice for MIE in view of better QOL after operation, although it has higher risk of anastomotic leak that might lead to worse QOL in early period. |
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