Lasting Symptoms After Esophageal Resection (LASER): European Multicenter Cross-sectional Study

Sheraz R. Markar*, Giovanni Zaninotto, Carlo Castoro, Asif Johar, Pernilla Lagergren, Jessie A. Elliott, Suzanne S. Gisbertz, Christophe Mariette, Rita Alfieri, Jeremy Huddy, Viknesh Sounderajah, Eleonora Pinto, Marco Scarpa, Fredrik Klevebro, Berit Sunde, Conor F. Murphy, Christine Greene, Narayanasamy Ravi, Guillaume Piessen, Hylke BrenkmanJelle P. Ruurda, Richard Van Hillegersberg, Sjoerd Lagarde, Bas Wijnhoven, Manuel Pera, José Roig, Sandra Castro, Robert Matthijsen, John Findlay, Stefan Antonowicz, Nick Maynard, Orla Mccormack, Arun Ariyarathenam, Grant Sanders, Edward Cheong, Shameen Jaunoo, William Allum, Jan Van Lanschot, Magnus Nilsson, John V. Reynolds, Mark I.van Berge Henegouwen, George B. Hanna

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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 ± 0.02 and 0.82 ± 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.

Original languageEnglish
Pages (from-to)E392-E400
JournalAnnals of Surgery
Issue number2
Publication statusPublished - 1 Feb 2022

Bibliographical note

Funding Information:
Mr S.R.M. received the European Society for Medical Oncology Clinical Research Fellowship for the support of this study. Mr S.R.M. is supported by an NIHR Academic Clinical Lectureship and acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC). This study was also supported by the NIHR London IVD Co-operative and the Morgagni Charity. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Publisher Copyright:
© 2022 Wolters Kluwer Health, Inc. All rights reserved.


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