Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 30;9(11):3513.
doi: 10.3390/jcm9113513.

Long-Term, Health-Related Quality of Life after Open and Robot-Assisted Ivor-Lewis Procedures-A Propensity Score-Matched Study

Anne-Sophie Mehdorn  1 , Thorben Möller  1 , Frederike Franke  1 , Florian Richter  1 , Jan-Niclas Kersebaum  1 , Thomas Becker  1 , Jan-Hendrik Egberts  1
Affiliations

Long-Term, Health-Related Quality of Life after Open and Robot-Assisted Ivor-Lewis Procedures-A Propensity Score-Matched Study

Anne-Sophie Mehdorn et al. J Clin Med. .

Abstract

Esophagectomies are among the most invasive surgical procedures that highly influence health-related quality of life (HRQoL). Recent improvements have helped to achieve longer survival. Therefore, long-term postoperative HRQoL needs to be emphasized in addition to classic criterions like morbidity and mortality. We aimed to compare short and long-term HRQoL after open transthoracic esophagectomies (OTEs) and robotic-assisted minimally invasive esophagectomies (RAMIEs) in patients suffering from esophageal adenocarcinoma. Prospectively collected HRQoL-data (from the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-C30 (EORTC QLQ-C30)) were correlated with clinical courses. Only patients suffering from minor postoperative complications (Clavien-Dindo Classification of < 2) after R0 Ivor-Lewis-procedures were included. Age, sex, body mass index (BMI), American Society of Anesthesiologists physical status-score (ASA-score), tumor stage, and perioperative therapy were used for propensity score matching (PSM). Twelve RAMIE and 29 OTE patients met the inclusion criteria. RAMIE patients reported significantly better emotional and social function while suffering from significantly less pain and less physical impairment four months after surgery. The long-term follow up confirmed the results. Long-term postoperative HRQoL and self-perception partly exceeded the levels of the healthy reference population. Minor operative trauma by robotic approaches resulted in significantly reduced physical impairments while improving HRQoL and self-perception, especially in the long-term. However, further long-term results are warranted to confirm this positive trend.

Keywords: Ivor-Lewis procedure; esophageal cancer; esophagectomy; health-related quality of life; robotic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient inclusion into the study. OTE: open transthoracic esophagectomy; RAMIE: robot-assisted minimally-invasive esophagectomy; HRQoL: health-related quality of life.
Figure 2
Figure 2
Survival stratified by the cohorts—RAMIE (red) vs. OTE (green). (A) overall survival; (B) disease-free survival. Kaplan–Meier survival curves and the log-rank test were used to compare survival. DFS: disease-free survival; OS: overall survival; OTE: open transthoracic esophagectomy; RAMIE: robot-assisted minimally-invasive esophagectomy.
Figure 3
Figure 3
Quality of life and symptoms stratified by cohorts—RAMIE (black) vs. OTE (grey). (A) Global health status; (B) fatigue; (C) nausea/vomiting; (D) pain; E: dyspnea; (F) insomnia; (G) appetite loss; (H) constipation; (I) diarrhea; and (J) financial difficulties. OTE: open transthoracic esophagectomy; RAMIE: robot-assisted minimally-invasive esophagectomy.
Figure 4
Figure 4
Function stratified by cohorts—RAMIE (black) vs. OTE (grey). (A) Physical function; (B) role function; (C) emotional function; (D) cognitive function; and (E) social function. OTE: open transthoracic esophagectomy; RAMIE: robot-assisted minimally-invasive esophagectomy.
Figure 5
Figure 5
Quality of life and symptoms in the propensity score matching (PSM) analysis stratified by cohorts—RAMIE (black) vs. OTE (grey). (A) Global health status; (B) fatigue; (C) nausea/vomiting; (D) pain; (E) dyspnea; (F) insomnia; (G) appetite loss; (H) constipation; (I) diarrhea; and (J) financial difficulties. OTE: open transthoracic esophagectomy; RAMIE: robot-assisted minimally-invasive esophagectomy.
Figure 6
Figure 6
Function in the PSM analysis stratified by cohorts—RAMIE (black) vs. OTE (grey). (A) Physical function; (B) role function; (C) emotional function; (D) cognitive function; and (E) social function. RAMIE: robot-assisted minimally-invasive esophagectomy; OTE: open transthoracic esophagectomy.
See this image and copyright information in PMC

References

    1. Jezerskyte E., Saadeh L.M., Hagens E.R.C., Sprangers M.A.G., Noteboom L., van Laarhoven H.W.M., Eshuis W.J., van Berge Henegouwen M.I., Gisbertz S.S. Long-term quality of life after total gastrectomy versus ivor lewis esophagectomy. World J. Surg. 2020;44:838–848. doi: 10.1007/s00268-019-05281-8. - DOI - PubMed
    1. Siegel R.L., Miller K.D., Jemal A. Cancer Statistics, 2019. CA Cancer J. Clin. 2019;69:7–34. doi: 10.3322/caac.21551. - DOI - PubMed
    1. Gisbertz S.S., Hagens E.R.C., Ruurda J.P., Schneider P.M., Tan L.J., Domrachev S.A., Hoeppner J., van Berge Henegouwen M.I. The evolution of surgical approach for esophageal cancer. Ann. N. Y. Acad. Sci. 2018;1434:149–155. doi: 10.1111/nyas.13957. - DOI - PubMed
    1. Mariette C., Markar S., Dabakuyo-Yonli T.S., Meunier B., Pezet D., Collet D., D‘Journo X.B., Brigand C., Perniceni T., Carrere N., et al. Health-related quality of life following hybrid minimally invasive versus open esophagectomy for patients with esophageal cancer, analysis of a multicenter, open-label, randomized phase iii controlled trial—The MIRO trial. Ann. Surg. 2019;271:1023–1029. doi: 10.1097/SLA.0000000000003559. - DOI - PubMed
    1. Yoshida N., Yamamoto H., Baba H., Miyata H., Watanabe M., Toh Y., Matsubara H., Kakeji Y., Seto Y. Can minimally invasive esophagectomy replace open esopahgectomy for esophageal cancer? Latest analysis of 24,233 esophagectomies from the japanese national clinical database. Ann. Surg. 2019;272:118–124. doi: 10.1097/SLA.0000000000003222. - DOI - PubMed

LinkOut - more resources