• Andrew P Barbour, Orla M Mc Cormack, Peter J Baker, Jodi Hirst, Lutz Krause, Sandra Brosda, Janine M Thomas, Jane M Blazeby, Iain G Thomson, David C Gotley, and Bernard M Smithers.
• *Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia †Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia ‡Epidemiology & Biostatistics, School of Public Health, The University of Queensland, Public Health Building, Herston, Queensland, Australia §The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia ¶The University of Queensland, Diamantina Institute and School of Medicine, Translational Research Institute, Woolloongabba, Queensland, Australia ||Mater Medical Research Institute, Mater Health Services, Raymond Terrace, South Brisbane, Australia **Bristol Centre for Surgical Research, School of Social & Community Medicine, University of Bristol, Bristol, UK.
• Ann. Surg. 2017 Jun 1; 265 (6): 1158-1165.

ObjectiveThe aim of this study was to assess long-term health-related quality of life (HRQL) in patients after thoracoscopic and open esophagectomy.Summary Of Background DataTrials comparing minimally invasive with open transthoracic esophagectomy have shown improved short-term outcomes; however, long-term HRQL data are lacking. This prospective nonrandomized study compared HRQL and survival after thoracoscopically assisted McKeown esophagectomy (TAMK) and open transthoracic Ivor Lewis esophagectomy (TTIL) for esophageal or gastroesophageal junction (GEJ) cancer.MethodsPatients with esophageal or GEJ cancer selected for TAMK or TTIL completed baseline and follow-up HRQL assessments for up to 24 months using the EORTC generic and disease-specific measures, QLQ-C30 and QLQ-OES18. Baseline clinical variables were examined between the treatment groups and changes in mean HRQL scores over time estimated and tested using generalised estimating equations with propensity score (generated by boosted regression) adjustment.ResultsOf the 487 patients, 377 underwent TAMK and 110 underwent TTIL. Most clinical variables were similar in the 2 groups; however, there were significantly more patients with AJCC stage 3 disease who underwent TTIL than TAMK (54% vs 32%, P < 0.01) and this was reflected in the survival data.Mean symptom scores for pain were significantly higher in the TTIL group than in TAMK for 2 years postoperatively (P = 0.036). In addition, mean constipation scores were significantly higher for the TTIL group, with a 15-point difference in mean score at 3 months postoperatively (P = 0.037).ConclusionsThis large comprehensive nonrandomized analysis of longitudinal HRQL shows that TTIL is associated with more pain and constipation than TAMK.

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