• B J Noordman, E W de Bekker-Grob, Coene P P L O PPLO Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands., E van der Harst, S M Lagarde, J Shapiro, Wijnhoven B P L BPL Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands., and van Lanschot J J B JJB Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands..
• Department of Surgery, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
• Br J Surg. 2018 Nov 1; 105 (12): 1630-1638.

BackgroundAfter neoadjuvant chemoradiotherapy (nCRT) plus surgery for oesophageal cancer, 29 per cent of patients have a pathologically complete response in the resection specimen. Active surveillance after nCRT (instead of standard oesophagectomy) may improve health-related quality of life (HRQoL), but patients need to undergo frequent diagnostic tests and it is unknown whether survival is worse than that after standard oesophagectomy. Factors that influence patients' preferences, and trade-offs that patients are willing to make in their choice between surgery and active surveillance were investigated here.MethodsA prospective discrete-choice experiment was conducted. Patients with oesophageal cancer completed questionnaires 4-6 weeks after nCRT, before surgery. Patients' preferences were quantified using scenarios based on five aspects: 5-year overall survival, short-term HRQoL, long-term HRQoL, the risk that oesophagectomy is still necessary, and the frequency of clinical examinations using endoscopy and PET-CT. Panel latent class analysis was used.ResultsSome 100 of 104 patients (96·2 per cent) responded. All aspects, except the frequency of clinical examinations, influenced patients' preferences. Five-year overall survival, the chance that oesophagectomy is still necessary and long-term HRQoL were the most important attributes. On average, based on calculation of the indifference point between standard surgery and active surveillance, patients were willing to trade off 16 per cent 5-year overall survival to reduce the risk that oesophagectomy is necessary from 100 per cent (standard surgery) to 35 per cent (active surveillance).ConclusionPatients are willing to trade off substantial 5-year survival to achieve a reduction in the risk that oesophagectomy is necessary.© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

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