Population-based study of surgical factors in relation to health-related quality of life after oesophageal cancer resection

Background: Oesophagectomy for cancer has a negative impact on health-related quality of life (HRQL), but factors influencing postoperative HRQL have been sparsely studied. This study explored how selected surgical factors affected HRQL 6 months after operation. Methods: This population-based study was based on a Swedish network of physicians with almost complete nationwide coverage and data on oesophageal cancer surgery collected prospectively between 2001 and 2005. Patients completed validated HRQL questionnaires 6 months after operation. Mean scores with 95 per cent confidence intervals were calculated and clinically relevant differences between groups were analysed in a linear regression model, adjusted for potential confounders. Results: Some 3 5 5 patients were included in the analysis (participation rate 79.6 per cent). Extensive surgery, as indicated by a transthoracic approach, more extensive lymphadenectomy, wider resection margins and a longer duration of operation, was not associated with worse HRQL measures than less extensive operations. Dysphagia was similar in patients who had handsewn and stapled anastomoses. Technical surgical complications had significant deleterious effects on several aspects of HRQL. Conclusion: This study provides no evidence to suggest that less extensive surgery for oesophageal cancer should be recommended from the perspective of HRQL. It is essential, however, that attention be paid to minimizing technical surgical complications.