Serious complications after oesophageal surgery cause lasting health problems in long-term survivors
Oesophageal cancer is a very serious form of cancer that, if not fatal, requires extensive surgery. A new study from Karolinska Institutet shows that when serious complications arise after surgery for oesophageal cancer, many patients suffer other health problems, such as breathlessness, fatigue, insomnia and eating problems, for five years afterwards.
"Patients who suffer serious post-operative complications after surgery for oesophageal cancer need very close, long-term monitoring so that any problems that arise can be identified and targeted quickly," says research team member Maryam Derogar, doctoral student at the Department of Molecular Medicine and Surgery.
Oesophageal cancer is the eighth most common form of cancer in the world. The disease is often discovered at a late stage once the symptoms, such as difficulties swallowing and weight loss, have occurred. The most established curative treatment is radical surgery that often incorporates the abdomen, chest and throat. Surgery is only performed on 25 to 33 per cent of patients, a third of whom survive for at least 5 years after the operation. The research team recently showed that one in six patients who underwent surgery for oesophageal cancer had an impaired quality of life to a level well below the national average.
The aim of the current study, which is published in The Journal of Clinical Oncology, was to ascertain whether serious complications following surgery for oesophageal cancer affect the quality of life among patients who survive for at least five years after their operation.
The researchers studied the quality of life trends for 141 patients who had undergone surgery for oesophageal cancer in Sweden between 2001 and 2005 and who had survived for at least 5 years afterwards. They found that 45 (roughly one third) of these patients suffered from at least one serious postoperative complication, such as chronic respiratory insufficiency or severe infection.
The patients were asked to rate their quality of life by answering a questionnaire concerning functional (e.g. physical, social and emotional function) capacity and symptoms (e.g. pain, fatigue and eating problems) at 6 months, 3 years and 5 years after surgery. After converting their responses to scores on 0 to 100 scale (where high scores for functionality and low scores for symptoms were good), the researchers made a statistical comparison of quality of life between patients who suffered serious postoperative complications and those who did not, taking into account age (at operation), sex, other health problems, type of surgery, and type and stage of tumour.
They found that patients who suffered a serious postoperative complication had more symptoms of breathlessness, fatigue and eating problems than those who had not had such complications. The impairments were apparent six months following surgery and remained unchanged for 5 years. These patients also had problems with insomnia and heartburn.
Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery.
J. Clin. Oncol. 2012 May;30(14):1615-9