Lasting Symptoms After Esophageal Resection (LASER)

Abstract

Objective: To identify the most prevalent symptoms and those with greatest impact upon health-related quality of life (HRQOL) among esophageal cancer survivors. Background: Long-term symptom burden after esophagectomy, and associations with HRQOL, are poorly understood.Patients and Methods: Between 2010 and 2016, patients from 20 European Centers who underwent esophageal cancer surgery, and were disease-free at least 1 year postoperatively were asked to complete LASER, EORTC-QLQ-C30, and QLQ-OG25 questionnaires. Specific symptom questionnaire items that were associated with poor HRQOL as identified by EORTC QLQ-C30 and QLQ-OG25 were identified by multivariable regression analysis and combined to form a tool. Results: A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had symptoms associated with their esophagectomy. Ongoing weight loss was reported by 10.4% of patients, and only 13.8% returned to work with the same activities. Three LASER symptoms were correlated with poor HRQOL on multivariable analysis; pain on scars on chest (odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81 AE 0.02 and 0.82 AE 0.09 respectively. Conclusion: Two-thirds of patients experience significant symptoms more than 1 year after surgery. The 3 key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased support.

Postoperative Complications and Long-Term Quality of Life After Multimodality Treatment for Esophageal Cancer: An Analysis of the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP)

“…A recent prospective multicenter study showed that the majority of patients have functional complaints that last up to more than 1 year after an esophagectomy. 29 The authors found a relation between the absence of 30-day complications and HR-QoL, with an increased physical, social, role functioning, and global health status in the group without complications.…”

Influence of postoperative complications following esophagectomy for cancer on quality of life: A European multicenter study

“…The LASER study is a prospective European multicenter cross-sectional study, which aimed to identify symptoms with the highest incidence and the greatest impact on HRQL in disease-free patients following an esophagectomy for esophageal or gastro-esophageal junction cancer. [22] The primary study outcomes of the LASER study have been published before. [22] Ethical approval to use the LASER study dataset for side studies were gained by each participating centre during the original LASER study, and written informed consent was signed by all participants to use their data in retrospective studies.…”

“…[20,21] Therefore the primary aim of this study was to examine whether long-term HRQL differs with the occurrence and severity of postoperative complications in a European multicenter prospective dataset J o u r n a l P r e -p r o o f of esophagectomy patients (LASER study). [22] We hypothesized that the severity of postoperative complications are proportionally negatively associated with long-term HRQL: patients with severe complications are likely to have significantly worse long-term HRQL compared to patients with no or minor postoperative complications.…”

Validation of data quality in a nationwide gastroenterological surgical database: The National Clinical Database site‐visit and remote audits, 2016‐2018

“…NCD users usually enter data 90 days after surgery to provide data on 90-day mortality, and weight loss often occurs at the time of data entry, especially after esophagectomy, gastrectomy, and pancreaticoduodenectomy. [15][16][17] The concordance rates for data on wound class (92.7%), ASA class (87.2%), and anesthesia technique (90.5%) were also <95%. To reduce the number of disagreements, we have added several alarms on the NCD web input form from 2016.…”