This study is aimed to assess the long-term health-related quality of life(HRQL) of patients after esopha-gectomy for esophageal cancer in comparison with es-tablished norms,and to evaluate changes in HRQL during the ...This study is aimed to assess the long-term health-related quality of life(HRQL) of patients after esopha-gectomy for esophageal cancer in comparison with es-tablished norms,and to evaluate changes in HRQL during the different stages of follow-up after esopha-geal resection. A systematic review was performed bysearching medical databases(Medline,Embase andthe Cochrane Library) for potentially relevant studiesthat appeared between January 1975 and March 2011.Studies were included if they addressed the questionof HRQL after esophageal resection for esophage alcancer. Two researchers independently performed the study selection,data extraction and analysis processes.Twenty-one observational studies were included witha total of 1282(12-355) patients. Five studies were performed with short form-36(SF-36) and 16 with European Organization for Research and Treatment of Cancer(EORTC) QLQ C30(14 of them also utilized the disease-specific OES18 or its previous version OES24) .The analysis of long-term generic HRQL with SF-36showed pooled scores for physical,role and socialfunction after esophagectomy similar to United Statesnorms,but lower pooled scores for physical function,vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 globalscale during a 6-mo follow-up showed that global scaleand physical function were better at the baseline. The symptom scales indicated worsened fatigue,dyspneaand diarrhea 6 mo after esophagectomy. In contrast,however,emotional function had significantly improved after 6 mo. In conclusion,short- and long-term HRQLis deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-termconsequence of esophagectomy involving either the respiratory system or the alimentary tract. The short-and long-term improvement in the emotional function of patients who have undergone successful operationsmay be attributed to the impression that they have survived a near-death experience.展开更多
AIM:To evaluate quality of life(QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were...AIM:To evaluate quality of life(QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were assigned to Ivor Lewis(n = 30),combined thoracoscopic/laparoscopic(n = 30),and left transthoracic(n = 30) esophagectomy groups.The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer,both developed by the European Organization for Research and Treatment of Cancer,were used to evaluate patients' QOL from 1 wk before to 24 wk after surgery.RESULTS:A total of 324 questionnaires were collected from 90 patients;36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits.QOL declined markedly in all patients at 1 wk postoperatively:preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis,combined thoracoscopic/laparoscopic,and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1(P < 0.001),81.1 ± 9.0 vs 53.3 ± 11.5(P < 0.001),and 83.6 ± 11.2 vs 46.4 ± 11.3(P < 0.001),respectively.Thereafter,QOL recovered gradually in all patients.Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL;global scores were lower in this group than in the combined thoracoscopic/laparoscopic(P < 0.001) and left transthoracic(P < 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively.QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy,and most indices had recovered to preoperative levels at 24 wk postoperatively.In the Ivor Lewis and combined thoracoscopic/laparoscopic groups,pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9(P < 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2(P = 0.02),respectively,at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6(P = 0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3(P = 0.003),respectively,at 24 wk postoperatively.Scores in the left transthoracic esophagectomy group fell between those of the other two groups.CONCLUSION:Compared with Ivor Lewis and left transthoracic esophagectomies,combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL,making it a preferable surgical approach for esophageal cancer.展开更多
Incidence of esophageal cancer(EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy,more than 50% of patients have incurable disease at the time of presentation.Th...Incidence of esophageal cancer(EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy,more than 50% of patients have incurable disease at the time of presentation.This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom,the optimum management is not established.Self-expanding metal stents(SEMS) are a well-established palliation modality for dysphagia in such patients.Health-related quality of life(HRQoL) is becoming a major issue in the evaluation of any therapeuticor palliative intervention.To date,only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation.The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC.All Medline articles regarding HRQoL in patients with advanced EC,particularly those related to SEMS,were reviewed.In most studies,relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy. SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia,recurrent dysphagia and better HRQoL,although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions.展开更多
Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who u...Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of Oncology（IOV-IRCCS） between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference（MD） of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment. Results： Jejunostomy was performed in 40 on 109 patients（41.3%） who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission（P=0.009） became not clinically significant at 3 months after surgery（MD =9.1）. Jejunostomy was associated to clinically and statistically significantly poorer emotional function（EF） at 3 months after surgery（MD =-15.6; P=0.04）. Hospital stay was longer in jejunostomy group（median, 20 vs. 17 days, P=0.02）.Conclusions： In our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.展开更多
Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic r...Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic resection(ER)presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks,but it is associated with higher rates of cancer recurrence following the procedure.For some patients,age and comorbidities may prevent them from having esophagectomy as a treatment option,while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences.Furthermore,while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life(QOL),so might the morbidity surrounding esophagectomy.In addition to considering health status,patient preferences,and impacts on QOL,physicians and patients must also consider what treatments would be both beneficial and available to the patient,considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER.Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data.We conclude with a request for more research of available options for early EAC patients,the conditions that determine when each option should be employed,and their effects not only on patient health but also QOL.展开更多
AIM To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.METHODS A total of 281 cases of dig...AIM To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.METHODS A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus,stomach, duodenum and jejunum), per anal (colon and rectum ) and percutaneous transhepatic ( biliary )installation of metallic stent. Among them, 205 cases received drug infusion by cannulation of tumor supplying artery with Seldingers technique.RESULTS Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8 - 43 weeks among those with intraarterial drug infusion, which was later than 4 - 26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3 - 105) weeks,which was significantly longer than 15 (3- 24) weeks of the latter group.CONCLUSION Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.展开更多
文摘This study is aimed to assess the long-term health-related quality of life(HRQL) of patients after esopha-gectomy for esophageal cancer in comparison with es-tablished norms,and to evaluate changes in HRQL during the different stages of follow-up after esopha-geal resection. A systematic review was performed bysearching medical databases(Medline,Embase andthe Cochrane Library) for potentially relevant studiesthat appeared between January 1975 and March 2011.Studies were included if they addressed the questionof HRQL after esophageal resection for esophage alcancer. Two researchers independently performed the study selection,data extraction and analysis processes.Twenty-one observational studies were included witha total of 1282(12-355) patients. Five studies were performed with short form-36(SF-36) and 16 with European Organization for Research and Treatment of Cancer(EORTC) QLQ C30(14 of them also utilized the disease-specific OES18 or its previous version OES24) .The analysis of long-term generic HRQL with SF-36showed pooled scores for physical,role and socialfunction after esophagectomy similar to United Statesnorms,but lower pooled scores for physical function,vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 globalscale during a 6-mo follow-up showed that global scaleand physical function were better at the baseline. The symptom scales indicated worsened fatigue,dyspneaand diarrhea 6 mo after esophagectomy. In contrast,however,emotional function had significantly improved after 6 mo. In conclusion,short- and long-term HRQLis deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-termconsequence of esophagectomy involving either the respiratory system or the alimentary tract. The short-and long-term improvement in the emotional function of patients who have undergone successful operationsmay be attributed to the impression that they have survived a near-death experience.
文摘AIM:To evaluate quality of life(QOL) following Ivor Lewis,left transthoracic,and combined thoracoscopic/laparoscopic esophagectomy in patients with esophageal cancer.METHODS:Ninety patients with esophageal cancer were assigned to Ivor Lewis(n = 30),combined thoracoscopic/laparoscopic(n = 30),and left transthoracic(n = 30) esophagectomy groups.The QOL-core 30 questionnaire and the supplemental QOL-esophageal module 18 questionnaire for patients with esophageal cancer,both developed by the European Organization for Research and Treatment of Cancer,were used to evaluate patients' QOL from 1 wk before to 24 wk after surgery.RESULTS:A total of 324 questionnaires were collected from 90 patients;36 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits.QOL declined markedly in all patients at 1 wk postoperatively:preoperative and 1-wk postoperative global QOL scores in the Ivor Lewis,combined thoracoscopic/laparoscopic,and left transthoracic groups were 80.8 ± 9.3 vs 32.0 ± 16.1(P < 0.001),81.1 ± 9.0 vs 53.3 ± 11.5(P < 0.001),and 83.6 ± 11.2 vs 46.4 ± 11.3(P < 0.001),respectively.Thereafter,QOL recovered gradually in all patients.Patients who underwent Ivor Lewis esophagectomy showed the most pronounced decline in QOL;global scores were lower in this group than in the combined thoracoscopic/laparoscopic(P < 0.001) and left transthoracic(P < 0.001) groups at 1 wk postoperatively and was not restored to the preoperative level at 24 wk postoperatively.QOL declined least in patients undergoing combined thoracoscopic/laparoscopic esophagectomy,and most indices had recovered to preoperative levels at 24 wk postoperatively.In the Ivor Lewis and combined thoracoscopic/laparoscopic groups,pain and physical function scores were 78.9 ± 18.5 vs 57.8 ± 19.9(P < 0.001) and 59.3 ± 16.1 vs 70.2 ± 19.2(P = 0.02),respectively,at 1 wk postoperatively and 26.1 ± 28.6 vs 9.5 ± 15.6(P = 0.007) and 88.4 ± 10.5 vs 95.8 ± 7.3(P = 0.003),respectively,at 24 wk postoperatively.Scores in the left transthoracic esophagectomy group fell between those of the other two groups.CONCLUSION:Compared with Ivor Lewis and left transthoracic esophagectomies,combined thoracoscopic/laparoscopic esophagectomy enables higher postoperative QOL,making it a preferable surgical approach for esophageal cancer.
文摘Incidence of esophageal cancer(EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy,more than 50% of patients have incurable disease at the time of presentation.This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom,the optimum management is not established.Self-expanding metal stents(SEMS) are a well-established palliation modality for dysphagia in such patients.Health-related quality of life(HRQoL) is becoming a major issue in the evaluation of any therapeuticor palliative intervention.To date,only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation.The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC.All Medline articles regarding HRQoL in patients with advanced EC,particularly those related to SEMS,were reviewed.In most studies,relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy. SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia,recurrent dysphagia and better HRQoL,although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions.
基金supported by Current Research Fund from Italian Ministry of Health to Carlo Castoro grant from Berlucchi Foundation （Brescia, Italy） to Carlo Castoro
文摘Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of Oncology（IOV-IRCCS） between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference（MD） of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment. Results： Jejunostomy was performed in 40 on 109 patients（41.3%） who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission（P=0.009） became not clinically significant at 3 months after surgery（MD =9.1）. Jejunostomy was associated to clinically and statistically significantly poorer emotional function（EF） at 3 months after surgery（MD =-15.6; P=0.04）. Hospital stay was longer in jejunostomy group（median, 20 vs. 17 days, P=0.02）.Conclusions： In our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.
文摘Esophagectomy is considered the primary form of management for esophageal adenocarcinoma(EAC);however,the surgery is associated with high rates of morbidity and mortality.For patients with early-stage EAC,endoscopic resection(ER)presents a potential curative treatment option that is less invasive and carries fewer risks procedure related risks,but it is associated with higher rates of cancer recurrence following the procedure.For some patients,age and comorbidities may prevent them from having esophagectomy as a treatment option,while other patients may be operative candidates but do not wish to undergo esophagectomy for a variety of reasons related to their values and preferences.Furthermore,while anxiety of cancer recurrence following ER may significantly diminish a patient’s quality of life(QOL),so might the morbidity surrounding esophagectomy.In addition to considering health status,patient preferences,and impacts on QOL,physicians and patients must also consider what treatments would be both beneficial and available to the patient,considering esophagectomy methods-minimally invasive vs open-or the use of chemoradiotherapy in addition to ER.Our article reviews and summarizes available treatment options for patients with early EAC and their potential effects on the health and wellbeing of patients based on the current data.We conclude with a request for more research of available options for early EAC patients,the conditions that determine when each option should be employed,and their effects not only on patient health but also QOL.
文摘AIM To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.METHODS A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus,stomach, duodenum and jejunum), per anal (colon and rectum ) and percutaneous transhepatic ( biliary )installation of metallic stent. Among them, 205 cases received drug infusion by cannulation of tumor supplying artery with Seldingers technique.RESULTS Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8 - 43 weeks among those with intraarterial drug infusion, which was later than 4 - 26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3 - 105) weeks,which was significantly longer than 15 (3- 24) weeks of the latter group.CONCLUSION Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.
