Impact of oesophagectomy on physical fitness and health-related quality of life in patients with oesophageal cancer

Abstract

Although several studies have reported the impact of oesophagectomy on health-related quality of life (HRQOL), none has objectively assessed its impact on physical fitness. This study aimed to evaluate the impact of oesophagectomy on physical fitness and HRQOL in patients with oesophageal cancer. In this prospective study, we investigated 30 consecutive patients with newly diagnosed resectable oesophageal cancer who were scheduled to receive either neoadjuvant chemotherapy followed by surgery or surgery alone. The primary end-points were change from baseline in two measures of physical fitness (knee-extensor muscle strength and 6-min walking distance) after oesophagectomy. The secondary end-point was change from baseline in HRQOL measured with the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire with 30 items (EORTC QLQ-C30). Physical fitness was significantly lower after oesophagectomy than before oesophagectomy (P < 0.001). With regard to HRQOL, there was a significant pre- to post-oesophagectomy change in most of the scales. In the multiple regression analysis, the change in 6-min walking distance was the only significant variable affecting the change in physical functional score on the EORTC QLQ-C30 (P = 0.032). In conclusion, oesophagectomy adversely affects physical fitness and HRQOL in patients with oesophageal cancer. Six-minute walking distance may be a good indicator of HRQOL shortly after oesophagectomy.

Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy

“…Even in the three patients who underwent video-assisted thoracic surgery, the mean decrease in 6MWD was 60 m, above the clinically important value. Our results were consistent with the previous report by Tatematsu et al that 6MWD and knee-extensor muscle strength, which were measured on the day of hospital discharge (median 21 days after surgery), were significantly decreased after esophagectomy [13]. Tatematsu et al also reported that the change in the physical functional score on EORTC QLQ-C30 was significantly affected by that in the 6MWD by multiple regression analysis [13].…”

“…At our institution, perioperative pulmonary rehabilitation is routinely performed on patients who underwent esophagectomy. In addition, physical, mental, and QOL status are routinely assessed before and after surgery as the perioperative rehabilitation program according to previous reports and guidelines [2, 10, 13, 16–19]. Patients are allowed to refuse the assessment if they do not wish.…”

“…In order to manage the rehabilitation program, it is important to adequately assess the status of functional exercise capacity and health-related quality of life (QOL) before surgery. Moreover, esophagectomy itself worsens health-related QOL and physical fitness [11–13]. A prospective study by Reynolds et al demonstrated that esophageal resection had a negative impact on health-related QOL as assessed by the 30-item European Organization for the Research and Treatment of Cancer (EORTC) QOL Core Questionnaires (QLQ) (EORTC QLQ-C30) [14] and esophageal cancer-specific EORTC QLQ (EORTC QLQ-OES24) [15] 3 months after surgery [12].…”

“…Moreover, Teoh et al reported that esophagectomy was associated with worsened physical functioning and fatigue symptoms as assessed by EORTC QLQ-C30 and QLQ-OES24 up to 6 months after treatment [11]. Tatematsu et al reported that 6MWD and knee-extensor muscle strength were significantly decreased approximately 3 weeks after esophagectomy [13]. However, the pre- and postoperative physical fitness, health-related QOL, psychological aspects, and their relationships have not been fully evaluated in patients with esophageal cancer who have undergone esophagectomy.…”

Clinical analysis of acute lung injury after esophagectomy

“…Although some patients can be cured, the treatment for esophageal cancer is protracted, diminishes the quality-of-life, and is lethal in a significant number of cases. [1,2] Prognosis of esophageal cancer is generally poor because of its biological aggressiveness and anatomic characteristics. [3] Esophagectomy, the surgical removal of all or part of the esophagus, is a surgical procedure that is associated with high morbidity and mortality.…”