Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
Comprehensive studies on long-term gastrointestinal functional results including DGCE after gastric conduit reconstruction are lacking. The aim of this study is to describe GI symptoms and symptoms of DGCE in relation to risk factors and global quality of life 1 year after diagnosis of esophageal cancer, in a large cohort.
Diagnostic, surgical and follow up data including EORTC QLQ-c30 and QLQ-OG25 patient reported outcome data 1 year after diagnosis, was extracted from the prospective, validated Swedish National Esophageal and Gastric Cancer Registry for the period 01.01.2006-31.05.2025. Cases not reconstructed with a gastric conduit, did not survive 1 year after diagnosis, lacking complete DGCE symptom data or diagnosed after 31.08.2024 were excluded. Baseline data was compared for responders and non-responders to the patient reported outcome questionnaires. Gastrointestinal symptoms were defined as clinically relevant if reported in the upper two levels of the symptom questions. Diagnostic criteria to determine DGCE symptom positivity were based on international Delphi based consensus criteria. DGCE symptom positivity was tested for association with risk factors and global quality of life. Odds-ratios and 95% confidence intervals were calculated for univariate analysis for correlation to baseline data and risk factors and logistic regression used for multivariable analysis.
Based on inclusion and exclusion criteria 2253 out of 13544 cases with history of esophageal cancer were included in the study. 1213 cases (53,8%) responded fully to the DGCE symptom questions and were included for symptom analysis. ASA-class, sex and age were similar in the responder and non-responder groups. The most common clinically relevant GI symptom was early satiety reported by 44% of cases. According to study criteria 322 cases (26.6%) were DGCE symptom positive 1 year after diagnosis. Risk of DGCE symptom positivity was not significantly different in females vs males, OR=1.21 CI (0.88-1.66). Cases were divided into 3 age-categories, 63 years and younger, 63-70 years and 71 years and older. Risk of DGCE symptom positivity was significantly higher in the youngest age-category, OR 1.66 CI (1.22-2.26). Further analysis, quality of life data and univariate and multivariate logistic regression results will be presented.
This is the first study based on international consensus criteria for DGCE diagnosis using a large prospectively collected nationwide database to report on the incidence of DGCE symptoms and correlation to risk factors. Approximately one fourth of individuals reported DGCE symptom positivity and younger age was associated with increased risk of DGCE symptom positivity. With increasing survival after esophagectomy for cancer, further research focus on DGCE pathophysiology, classification, prevention and treatment is highly justified.
M. Konradsson, Fredrik Klevebro, Magnus Nilsson· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Symptoms of delayed gastric conduit emptying are common in patients with a gastric conduit reconstruction after esophagectomy, but standardized radiologic evaluation is missing. We aim to describe the pattern of gastric conduit emptying by functional upper gastrointestinal contrast series, and to determine whether Barium or water soluble contrast is more suitable.
The study was approved by the Karolinska University Hospital Radiation Protection Committee and Regional Ethics Board of Stockholm. 30 patients were recruited at least 3 months after esophagectomy and filled in the DGCE symptom grading questionnaire developed in an international consensus process, and baseline data was registered. During a second appointment, radiology according to two phases of the radiology study protocol was performed. In the first phase, 2D frontal images were taken before, 2, 5, 10 and 20 minutes after swallowing 100 ml of water-soluble contrast fluid and at 30 minutes a low-radiation-dose computerized tomography was performed to better quantify possibly remaining contrast fluid. The second phase was performed in same manner using 100 ml of barium contrast. Two radiologists analyzed the images according to a pre-defined protocol, evaluating pillar length and area development as indicators of conduit emptying. Other factors evaluated were difficulty of evaluation, conduit form and risks
Thirty cases accepted to participate in the study, mean age was 68 years (range 52-83), 9 (30%) were female, mean ASA-score was 2,4 (range 2-3) and mean Charlson Comorbidity Index was 3 (range 1-8). All underwent water soluble contrast evaluation, but 5 were not evaluated with barium, due to: 1) large residual food content, 2) anastomotic leakage, 3) pulmonary embolism, 4) aspiration of water-soluble contrast and 5) consent withdrawal. In all cases of evaluation by Barium contrast it was possible to measure contrast pillar and contrast area, but in 5 cases of evaluation by water soluble contrast, poorly definable borders made measurement impossible. Subjectively the radiologists considered barium more trustworthy in 18 cases and easier to measure in 17 cases of the 25 cases available for comparison and the rest of the cases were considered equivalent. Area was considered less demanding than pillar length. Further results will be presented
Due to lack of standardization of functional radiology for individuals with a gastric conduit, methods of objective evaluation are lacking. This is the first study to attempt to describe the emptying function of the gastric conduit in 30 unselected individuals by contrast follow. Preliminary results indicate that area measurement and Barium contrast may be preferrable, but safety measures need to be taken, and the results need to be studied further in a multy-center study.
J. Hultkrantz, M. Konradsson, M. Andersson et al.· Diseases of the esophagus· 0 citations
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