Long-term health-related quality of life after McKeown and Ivor Lewis esophagectomy for esophageal carcinoma

Abstract

Summary Introduction Both cervical (McKeown) and intrathoracic (Ivor Lewis) anastomosis of transthoracic esophagectomy are surgical procedures that can be performed for distal esophageal or gastro-esophageal junction (GEJ) cancer. The purpose of this study was to investigate the long-term health-related quality of life (HR-QoL) after McKeown and Ivor Lewis esophagectomy in a tertiary referral center. Methods Disease-free patients >1 year following a McKeown or an Ivor Lewis esophagectomy with a two-field lymphadenectomy for a distal or GEJ carcinoma visiting the outpatient clinic between 2014 and 2018 were asked to complete the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. HR-QoL was investigated in both groups. Results A total of 89 patients were included after McKeown and 115 after Ivor Lewis esophagectomy. Median follow-up was 2.4 years (IQR 1.7–3.6). Patients after McKeown esophagectomy reported more problems with ‘eating with others’ compared to patients after Ivor Lewis esophagectomy (mean scores: 49.9 vs. 38.8). This difference was both clinically relevant and significant after correction for multiple testing (β = 11.1, 95% CI 3.105–19.127, P = 0.042). Patients in both groups reported a poorer HR-QoL (≥10 points) than the general population with respect to nausea and vomiting, dyspnea, appetite loss, financial difficulties, problems with eating, reflux, eating with others, choked when swallowing, trouble with coughing, and weight loss. Conclusion Long-term HR-QoL of disease-free patients following a McKeown or Ivor Lewis esophagectomy for a distal or GEJ carcinoma is largely comparable. Irrespective of the surgical technique, patients’ HR-QoL following esophagectomy is compromised. When given the choice, patients should be informed that after a McKeown esophagectomy more problems while eating with others can occur.

Feasibility of enhanced recovery protocol in minimally invasive McKeown esophagectomy

“…However, their main procedure was Ivor Lewis, which is different from our procedure of McKeown esophagectomy. McKeown esophagectomy has additional risks for laryngeal elevation disorder and recurrent nerve palsy compared to Ivor Lewis [13]. Sun et al reported early oral feeding on POD 1 for patients who underwent esophagectomy, including 3.2% of 3-field lymphadenectomy, was similar to late oral feeding on POD 7 with regard to postoperative pulmonary complications (22.1% vs. 28.6%, 95% confidence interval (CI): − 16.7-3.7%) and anastomotic leak (3.6% vs. 4.3%, 95% CI: − 5.3-3.9%).…”

“…Implementation of the ERAS protocol after esophagectomy was successful with respect to complications, postoperative hospital stay, and costs [8,[11][12][13][14][15][16][17][18][19][20][21][22]25]. In addition, postoperative EN after thoracoscopic esophagectomy was more favorable than total parental nutrition for bodyweight loss (-2.94 ± 3.19% vs. 5.05 ± 3.65%, P = 0.020) [26].…”

Transcatheter arterial embolization for delayed recurrent intrathoracic bleeding caused by anastomotic leakage after minimally invasive McKeown esophagectomy

“…Treatment for esophageal cancer usually consists of surgery combined with perioperative chemical (radio) therapy [1]. The incidence of AL after McKeown esophagectomy remains relatively high, which may be related to tube gastric perfusion, anastomotic tension, construction of the anastomosis [1,2].…”

“…Treatment for esophageal cancer usually consists of surgery combined with perioperative chemical (radio) therapy [1]. The incidence of AL after McKeown esophagectomy remains relatively high, which may be related to tube gastric perfusion, anastomotic tension, construction of the anastomosis [1,2]. The Esophageal Complications Consensus (ECCG) classi ed AL into three types, typ I: local defect requiring no change in therapy or treated medically or with dietary modi cation; typ II: localized defect requiring interventional (not surgical) therapy, for example, drain placement or stenting; typ III: localized defect necessitates surgical therapy [3].…”

“…The incidence of esophageal cancer is increasing recent decades, and the main treatment is surgery combined with neoadjuvant chemotherapy or neoadjuvant chemoradiation [1]. AL is a common complication following a minimally invasive McKeown esophagectomy, the severity of which ranges from asymptomatic to sepsis, accompanied by multiple organ failure, and is associated with high costs, a prolonged hospital stay, a serious deterioration in quality of life, and an increased mortality [1][2]. AL leading to delayed recurrent intrathoracic bleeding after MIE is a rare and life-threatening complication.…”