Esophageal Resection for Cancer of the Esophagus: Long-Term Function and Quality of Life

McLarty, Allison; Deschamps, Claude; Trastek, Victor F.; Allen, Mark S.; Pairolero, Peter C.; Harmsen, William S.

doi:10.1016/s0003-4975(97)00125-2

Cited by 235 publications

(175 citation statements)

References 19 publications

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“…Further details of the studies are given in Table 1. In general, all studies were considered deficient in one or more aspects of their study design/ reporting, which increased the likelihood of bias. In terms of selection, no eligibility criteria were reported in two studies [17,26], one prospective study used consecutive patients attending outpatient clinics [18] and all others used convenient samples from defined time periods [19][20][21][22][23][24][25][27][28][29][30][31][32][33]. Participation rate was reported in 16 of the 18 studies, and ranged between 66 and 100%.…”

Section: Resultsmentioning

confidence: 99%

“…Aghajanzadeh et al [17] noted that a more favourable weight profile and a reduced risk of oesophagitis was observed with the use of the colon as the esophageal substitute compared to the stomach, although no data were provided to support this assertion. Other factors that might influence nutritional outcome were reported by McLarty et al [30], who identified a cervical anastomosis to be associated with a lower risk of reflux symptoms compared to an intrathoracic (mediastinal) anastomosis. The authors also observed that dumping symptoms were more common in younger patients and in females compared to males.…”

Section: Surgical Approach and Techniquementioning

confidence: 87%

“…At six months, reported weight loss ranged from 5 to 12% [18,21,24,27]. The rate at which nutritional status deteriorated plateaued between six and 12 months after surgery, although in those studies reporting longer-term changes in nutritional status, 27-95% of subjects failed to return to their pre-operative levels [17,23,30]. This suggests that the early weight loss sustained post-operatively is not reversed.…”

Section: Changes In Nutritional Statusmentioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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SummaryBackground & aims-As improved outcomes after esophagectomy have been observed over the last two decades, the focus on care has shifted to survivorship and quality of life. The aim of this review was to determine changes in nutrition after esophagectomy and to assess the evidence for extended nutrition support.Methods-A search strategy was developed to identify primary research reporting change in nutritional status a minimum of one month after esophagectomy.Results-Changes in nutritional parameters reported by 18 studies indicated a weight loss of 5-12% at six months postoperatively. More than half of patients lost >10% of body weight at 12 months. One study reported a persistent weight loss of 14% from baseline three years after surgery. Three studies reporting on longer term follow up noted that 27%-95% of patients failed to regain their baseline weight. Changes in dietary intake (three studies) indicated inadequate energy and protein intake up to three years after surgery. Global quality of life scores reported in one study correlated with better weight preservation. There were a high frequency of gastrointestinal symptoms reported in six studies, most notably in the first year after surgery, but persisting up to 19 years. Extended enteral nutrition on a selective basis has been reported in several studies.Conclusions-Nutritional status is compromised in the months/years following oesophagectomy and may never return to baseline levels. The causes/consequences of weight loss/ impaired nutritional intake require further investigation. The role of extended nutritional support in this population remains unclear.

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Approach and Techniquementioning

confidence: 87%

Section: Changes In Nutritional Statusmentioning

confidence: 99%

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A systematic review of the nutritional consequences of esophagectomy

et al. 2016

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“…Como a deiscência de anastomose esofagogástrica cervical está relacionada ao aumento da morbidade pós-operatória e a efeitos deletérios na qualidade de vida a curto e longo prazo em comparação aos que não desenvolveram tal intercorrência 3,12,13,27,41,44,48,54,63 , a procura de alternativas técnicas visando minimizar ainda mais esta ocorrência faz-se justificada.…”

Section: Discussionunclassified

Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?

Fontes¹,

Kruse²,

Waechter³

et al. 2008

ABCD, arq. bras. cir. dig.

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INTRODUÇÃOA esofagectomia é procedimento cirúrgico complexo e tradicionalmente associado à morbidade significativa, tendo como principal indicação o tratamento da doença maligna. Neste caso, apesar dos progressos em outras modalidades terapêuticas, a esofagectomia persiste como tratamento de escolha em pacientes com tumores potencialmente ressecáveis, tanto com intento curativo quanto paliativo. Entretanto, na afecção maligna, cerca de 75% dos pacientes já apresentam doença avançada no momento do diagnóstico 24,25,59,62 . O câncer de esôfago figura entre os tumores sólidos mais letais, sendo referido universalmente como a sexta causa de morte dentre as neoplasias. Conforme estimativa do Instituto Nacional do Câncer -INCA, no Brasil são previstos registros de cerca de 10640 casos no ano de 2008.Atualmente, a seleção apurada de pacientes, associada ao aperfeiçoamento da anestesiologia, do rigor técnico e do manejo pré e pós-operatório em unidades de terapia intensiva resultaram em melhora significativa nas taxas de morbi-mortalidade destes pacientes 5,46,62 . Da mesma forma, a literatura evidencia que os bons resultados em procedimentos cirúrgicos complexos como a esofagectomia são volume dependentes 11,39,43,57 , com taxas de mortalidade hospitalar em serviços de excelência inferiores a 5% 62 .Após ressecção cirúrgica com intuito curativo, taxas de sobrevida em cinco anos são referidas entre 10 e 40% na maioria dos serviços de excelência. Já no Japão, Akiyama, entre outros, há muito refere resultados mais alentadores em cinco anos1. Por outro lado, visto o prognóstico reservado em nosso meio, é imperiosa a manutenção da qualidade de vida destes pacientes, concentrando esforços na prevenção de complicações que possam causar morbidade. Dentre estas, a mais temida é a deiscência da anastomose cervical, que é o calcanhar de Aquiles desta operação, com manifestações que oscilam entre a ocorrência benigna de sinus ou fístula até apresentações graves como mediastinite e óbito.Este estudo tem o objetivo de apresentar nova alternativa técnica de anastomose cervical visando diminuir a ocorrência de deiscência e consequentemente melhorar os resultados finais das esofagectomias (4):158-63 RESUMO -Racional -O câncer de esôfago é a sexta causa de morte relacionada à neoplasia no Brasil, e a esofagectomia quando factível é um dos pilares do tratamento, tanto com intento curativo quanto paliativo. A fístula cervical é complicação comum do procedimento e tem incidência entre 0,8 e 47, 6%. Objetivo -Testar a eficiência de uma alternativa técnica para a diminuição desta ocorrência. Métodos -Análise prospectiva de 126 pacientes alocados em dois grupos de acordo com a técnica utilizada para a anastomose esofagogástrica cervical. O grupo A, composto por 96 pacientes, teve a anastomose cervical realizada em dois planos, camadas mucosa com sutura contínua de fio categute cromado 3-0 ou caprofyl 3-0 e seromuscular com pontos separados de seda 3-0 agulhada, de forma tradicional, após ressecção prévia das extremidades redundantes do esôfa...

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“…Surgery for oesophageal cancer is often accompanied by significant morbidity (Zieren et al, 1996;Baba et al, 1997;McLarty et al, 1997;Blazeby et al, 2000;De Boer et al, 2000Brooks et al, 2002;Fagevik Olsen et al, 2005;Viklund et al, 2006). It has been reported that approximately 30% of patients will develop recurrent cancer within the first year after oesophageal resection.…”

mentioning

confidence: 99%

Nurse-led follow-up of patients after oesophageal or gastric cardia cancer surgery: a randomised trial

et al. 2008

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Between January 2004 and February 2006, 109 patients after intentionally curative surgery for oesophageal or gastric cardia cancer were randomised to standard follow-up of surgeons at the outpatient clinic (standard follow-up; n =55) or by regular home visits of a specialist nurse (nurse-led follow-up; n =54). Longitudinal data on generic (EuroQuol-5D, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and disease-specific quality of life (EORTC QLQ-OES18), patient satisfaction and costs were collected at baseline and at 6 weeks and 4, 7 and 13 months afterwards. We found largely similar quality-of-life scores in the two follow-up groups over time. At 4 and 7 months, slightly more improvement on the EQ-VAS was noted in the nurse-led compared with the standard follow-up group ( P =0.13 and 0.12, respectively). Small differences were also found in patient satisfaction between the two groups ( P =0.14), with spouses being more satisfied with nurse-led follow-up ( P =0.03). No differences were found in most medical outcomes. However, body weight of patients of the standard follow-up group deteriorated slightly ( P =0.04), whereas body weight of patients of the nurse-led follow-up group remained stable. Medical costs were lower in the nurse-led follow-up group (€2600 vs €3800), however, due to the large variation between patients, this was not statistically significant ( P =0.11). A cost effectiveness acceptability curve showed that the probability of being cost effective for costs per one point gain in general quality-of-life exceeded 90 and 75% after 4 and 13 months of follow-up, respectively. Nurse-led follow-up at home does not adversely affect quality of life or satisfaction of patients compared with standard follow-up by clinicians at the outpatient clinic. This type of care is very likely to be more cost effective than physician-led follow-up.

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Esophageal Resection for Cancer of the Esophagus: Long-Term Function and Quality of Life

Cited by 235 publications

References 19 publications

A systematic review of the nutritional consequences of esophagectomy

A systematic review of the nutritional consequences of esophagectomy

Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?

Nurse-led follow-up of patients after oesophageal or gastric cardia cancer surgery: a randomised trial

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