ESOPHAGEAL RESECTION FOR CANCER OF THE ESOPHAGUS - LONG-TERM FUNCTIONAND QUALITY-OF-LIFE

Background. Information on function and quality of life of long-term s urvivors after esophageal resection for carcinoma is limited. Methods. Between 1972 and 1990, 359 patients underwent esophagectomy for stage I or II esophageal carcinoma at Mayo Clinic. We evaluated long-term f unction and quality of life in 107 of these patients (81 men and 26 wo men) who survived 5 or more years. Median age at operation was 62 year s (range, 30 to 81 years). The operation performed was an Ivor Lewis r esection in 77 patients (72%), transhiatal esophagectomy in 14 (13%), extended esophagectomy in 4 (4%), thoracoabdominal esophagectomy in 4 (4%), and other in 8 (7%). Adenocarcinoma was present in 72 patients ( 67%), squamous cell carcinoma in 28 (26%), and other in 7 (7%). Thirty -four patients (32%) were in postsurgical stage I, 65 (61%) in stage I IA, and 8 (8%) in stage IIB. Median survival was 10.2 years (range, 5. 0 to 23.2 years). Follow-up was complete for all patients. Results. Ga stroesophageal reflux was present in 64 patients (60%), symptoms of du mping in 53 (50%), and dysphagia to solid food in 27 (25%). Seventeen patients (16%) were asymptomatic. Factors affecting late functional ou tcome were analyzed. Patients who had a cervical anastomosis had signi ficantly fewer reflux symptoms (p < 0.05). Dumping syndrome occurred m ore frequently in younger patients (p < 0.05) and women (p < 0.01). Qu ality of life was assessed separately by the Medical Outcomes Study 36 -Item Short-Form Health Survey and compared with the national norm. Sc ores measuring physical functioning were decreased (p < 0.01). Scores measuring ability to work, social interaction, daily activities, emoti onal dysfunction, perception of health, and levels of energy were simi lar. Mental health scores were higher (p < 0.05). Conclusions. We conc lude that long-term functional outcome after esophagectomy for esophag eal carcinoma is affected by age, sex, and type of reconstruction. Qua lity of life as judged by the patients is similar to the national norm . (C) 1997 by The Society of Thoracic Surgeons.