Reflux after esophagectomy with gastric conduit reconstruction in the posterior mediastinum for esophageal cancer: original questionnaire and EORTC QLQ-C30 survey

• Published in: Diseases of the esophagus Vol. 31; no. 7
• Main Authors: Nakahara, Y, Yamasaki, M, Miyazaki, Y, Tanaka, K, Makino, T, Takahashi, T, Kurokawa, Y, Nakajima, K, Takiguchi, S, Mori, M, Doki, Y
• Format: Journal Article
• Language: English
• Published: United States 01-07-2018
• Subjects: Aged; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - methods; Esophagogastric Junction - surgery; Female; Gastroesophageal Reflux - epidemiology; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - psychology; Humans; Male; Mediastinum - surgery; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - psychology; Postoperative Period; Quality of Life - psychology; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Surveys and Questionnaires; Treatment Outcome
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doy001

Reflux following an esophagectomy with gastric conduit reconstruction in the posterior mediastinum is a clinically significant problem. In this study, we investigated the frequency and impact of reflux on the quality of life (QOL) among 158 patients who underwent an esophagectomy for esophageal cancer using an original questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30). Reflux frequency was assessed using the original questionnaire. The number of patients who complained of reflux every day, two or three times a week, once a week, or less than once a week was 16 (10.1%), 21 (13.3%), 26 (16.5%), and 60 (38.0%), respectively. Out of 35 patients (22.2%) reported no reflux symptoms. Patients were divided into two groups: those with reflux ≥ once/week (63 patients) and those with low frequency of symptoms (95 patients). Time elapsed following surgery was the only factor to influence reflux frequency. Reflux frequency decreased within two years of surgery; however, the frequency plateaued after more than two years. QOL was assessed using the EORTC QLQ-C30. The ≥ once/week reflux group had a significantly lower global health status score than the low-frequency reflux group (59.6 ± 24.2 vs. 70.8 ± 20.7; P = 0.007). In addition, the ≥ once/week reflux group had a significantly lower social functioning score than the low-frequency reflux group (81.6 ± 24.1 vs. 88.4 ± 19.8; P = 0.035). Regarding symptoms, the ≥ once/week reflux group had significantly higher scores for fatigue, nausea, and vomiting, dyspnea and insomnia compared to the low-frequency reflux group (fatigue: 42.4 ± 21.9 vs. 28.9 ± 18.4, P < 0.001; nausea and vomiting: 17.3 ± 17.1 vs. 4.9 ± 10.6, P < 0. 001; dyspnea: 29.2 ± 26.0 vs. 21.7 ± 26.8, P = 0.043; insomnia: 22.2 ± 31.1 vs. 10.5 ± 21.7, P = 0.015). Thus, reflux after an esophagectomy was associated with a lower QOL.