Long-term trajectories of health-related quality of life after curative surgery in early-stage esophageal cancer: A prospective cohort study in Korea.

INTRODUCTION Although esophagectomy offers curative potential, patients commonly experience persistent gastrointestinal symptoms and reduced quality of life after surgery. While most health-related quality of life (HRQoL) data are derived from Western adenocarcinoma populations, East Asian patients predominantly have squamous cell carcinoma (SCC), often requiring extensive surgery. Longitudinal postoperative HRQoL data for this population remain limited. Therefore, we characterized longitudinal HRQoL after curative esophagectomy in Korean SCC patients.

Methods

We conducted a prospective cohort study of 284 patients who underwent curative esophagectomy at a tertiary center in Seoul, South Korea. HRQoL was assessed preoperatively and at 1, 6, and 12 months postoperatively using the EORTC QLQ-C30 and QLQ-OES18 questionnaires. Longitudinal changes were analyzed using linear mixed-effects models adjusted for age and stage. Clinically relevant symptoms were categorized into problem groups.

Results

Patients were predominantly male (95.8%) with SCC (93.3%) and early-stage disease (94.0%, stage I-II). Global health status declined from 63.4 at baseline to 49.8 at one month but recovered to near-baseline by 12 months. Physical and role functioning showed substantial early deterioration and remained below baseline at 12 months, whereas emotional functioning improved above baseline. Symptom burden peaked at one month, and fatigue, dyspnea, reflux, eating problems, and diarrhea remained elevated during follow-up.

Conclusions

Despite near-normal global health status, gastrointestinal and functional symptoms, particularly diarrhea, fatigue, and eating-related problems, persisted at 12 months in Korean patients with early-stage SCC. These findings underscore the need for multidisciplinary, phase-specific survivorship care for this population and caution against extrapolation from Western HRQoL data.