PD02.06. The ``Invisible Cost'' After Minimally Invasive Esophagectomy: Clinical Characteristics, Survival Impact, and Intervention Timing for Patients with Persistent Moderate-to-Severe Symptoms
Symptom persistence does not adversely affect overall survival; its association with improved DFS likely reflects the tumor-control benefit of adjuvant therapy.
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Persistent moderate-to-severe symptoms after minimally invasive esophagectomy (MIE) remain poorly characterized. While patient-reported outcomes (PROs) are increasingly recognized as important endpoints in surgical oncology, the prevalence, risk factors, optimal intervention timing, and prognostic impact of persistent postoperative symptom burden in esophageal squamous cell carcinoma (ESCC) patients have not been systematically evaluated. Understanding these factors is essential for developing evidence-based, timely symptom management strategies to improve postoperative recovery and quality of life.
We retrospectively analyzed 345 ESCC patients who underwent MIE at a single tertiary center. Symptoms were assessed using the MDASI, EORTC QLQ-C30, and QLQ-OES18 at baseline through 6 months postoperatively. Persistent moderate-to-severe symptoms at postoperative month 3 were defined by composite criteria (meeting any one): MDASI ≥3 core symptoms scoring ≥4; QLQ-C30 ≥2 functional domains below 66.7; or OES18 ≥2 symptom domains above 33.3. Independent risk factors were identified by multivariable logistic regression. Symptom trajectory analysis identified the critical divergence timepoint. Kaplan–Meier analysis, log-rank tests, multivariable Cox regression, and propensity score matching (1:1, 81 pairs) evaluated associations between symptom persistence and overall survival (OS) and disease-free survival (DFS).
At postoperative month 3, 89 patients (25.8%) met criteria for persistent moderate-to-severe symptoms. Independent risk factors were anastomotic leak (OR=7.92, P<0.001), adjuvant therapy (OR=3.05, P<0.001), and smoking history (OR=2.58, P=0.029); male sex was protective (OR=0.34, P=0.013). Predictive model AUC was 0.734. Symptom trajectories diverged at postoperative day 14. Five-year OS (63.5% vs 66.1%, HR=1.16, P=0.478) and DFS (72.9% vs 73.8%, HR=0.87, P=0.554) showed no significant differences. After propensity score matching (81 pairs), OS remained non-significant (HR=0.94, P=0.796), while DFS favored the persistent group (HR=0.55, P=0.029), potentially mediated by higher adjuvant therapy exposure.
Approximately one-quarter of post-MIE ESCC patients experience persistent moderate-to-severe symptoms at 3 months, primarily driven by anastomotic leak and adjuvant therapy. Symptom persistence does not adversely affect overall survival; its association with improved DFS likely reflects the tumor-control benefit of adjuvant therapy. Postoperative day 14 represents the critical symptom trajectory divergence point, providing an optimal window for initiating targeted PRO-based intervention.
A multimodal early warning system integrating PROs, laboratory trajectories, and large language model-extracted clinical text features to enable real-time, automated complication surveillance substantially outperforms single-modality approaches for detecting postoperative complications after esophagectomy.
Si-miao Lu, Yi Zhu, Yong-tao Han et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique
Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted, yet comparative patient-reported outcome (PRO) data against conventional minimally invasive esophagectomy (MIE) remains scarce. We aimed to compare perioperative PROs, including quality of life, nutritional status, cough-related quality of life, and anxiety, between RAMIE and MIE for esophageal squamous cell carcinoma (ESCC).
We enrolled 214 patients with ESCC who underwent RAMIE (n = 47) or conventional MIE (n = 167) from an ongoing prospective cohort study. PROs were assessed using the EQ-5D-5L, PG-SGA, Leicester Cough Questionnaire (LCQ), and Self-rating Anxiety Scale (SAS). A 1:1 propensity score-matched (PSM) analysis was performed to balance baseline covariates. Nutritional trajectory was tracked from admission through discharge using serial PG-SGA assessments.
Before PSM, the RAMIE group had significantly higher preoperative PG-SGA scores at admission (5.18 ± 3.32 vs 4.09 ± 3.01, P = 0.015) and pre-surgery (5.44 ± 3.69 vs 3.78 ± 2.88, P = 0.006), indicating worse baseline nutritional status. However, PG-SGA scores at discharge were comparable (4.56 ± 2.74 vs 4.42 ± 2.28, P = 0.931), demonstrating nutritional convergence. No significant differences were observed in EQ-5D-5L utility index (0.92 vs 0.93, P = 0.934), LCQ total score (121.6 vs 122.6, P = 0.751), or SAS standard score (45.4 vs 45.4, P = 0.551). The RAMIE group had a higher anastomotic leak rate (14.9% vs 4.8%, P = 0.025) but no Clavien-Dindo grade ≥III complications.
RAMIE and conventional MIE achieved comparable perioperative PROs in ESCC patients. Despite worse baseline nutritional status in the RAMIE group, nutritional recovery by discharge was equivalent. These findings support RAMIE as a viable alternative with comparable patient-centered outcomes, though the higher anastomotic leak rate warrants further investigation.
Si-miao Lu, Yi Zhu, Yong-tao Han et al.· Diseases of the esophagus· 0 citations
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
It is suggested that preoperative frailty assessment to target prehabilitation strategies, inform risk assessment, and support shared decision making are critical for improving long-term survival in esophageal cancer patients.
Lye-Yeng Wong, Ernest Chan, Tyler Wilson et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Other
Carcinoma of the esophagus significantly affects quality of life (QOL), particularly due to symptoms such as dysphagia and nutritional compromise. While transthoracic esophagectomy remains a standard curative modality, it is associated with substantial perioperative morbidity. Evaluation of postoperative QOL is essential to understand functional recovery and patient outcomes.
AIM
To study the impact of esophagectomy on health related quality of life (HR QOL) of patients with carcinoma esophagus.
OBJECTIVES
1.To determine baseline quality of life in patients with carcinoma esophagus planned for Mckeown’s esophagectomy.
2.To estimate the change in quality of life (QOL) indices over time in patients with carcinoma esophagus who underwent Mckeown’s esophagectomy.
METHODOLOGY
This prospective study included 50 patients with ECOG performance score of 0-2, who underwent transthoracic (McKeown) esophagectomy.Study was conducted from June 2024 to March 2026. QOL was assessed using EORTC QLQ-C30 and QLQ-OES18, patient administered questionnaires at preoperative, immediate postoperative period(3 week- 4 week), 3 months, and 6 months. Dysphagia was additionally evaluated using the physician administered Modified Takita grading system.Demographic data,disease and treatment related variables were collected from medical records. Statistical analysis included repeated measures ANOVA and Friedman test.
The mean age of patients was 59.46 ± 12.32 years, with a male predominance (76%). overall Global QOL showed a significant decline immediately, followed by a recovery at 3 months (48.23) and improvement beyond baseline at 6 months (66.84) (p < 0.001).All functional domains demonstrated a similar pattern of early decline followed by recovery and improvement.Symptom domains showed an inverse trend, with fatigue, pain, and appetite loss worsening postoperatively and improving over time.Esophageal cancer specific domains showed significant improvement, particularly dysphagia (49.17 → 29.55) and eating restriction. Saliva swallowing demonstrated a transient worsening at 3 months before improving at 6 months.Dysphagia assessment using Modified Takita grading showed significant improvement with time (p < 0.001).Subgroup analysis demonstrated significant associations of age, ECOG, and complication severity with postoperative QOL outcomes, while no statistically significant difference was observed with respect to surgical approach or treatment modality. Major complications were associated with poorer early postoperative recovery.
Transthoracic esophagectomy is associated with a transient decline in quality of life followed by progressive recovery and significant improvement by 6 months, with marked relief in dysphagia and related esophageal symptoms. Despite early postoperative morbidity, medium-term functional and symptomatic outcomes following McKeown’s esophagectomy are favorable.
J. HARI M S· Diseases of the esophagus· 0 citations
An end-to-end multimodal AI system can accurately automate PRO assessment from natural patient conversations and provide clinically meaningful early warning for postoperative complications, with external validation confirming generalisability across cohorts.
Si-miao Lu, Yi Zhu, Yong-tao Han et al.· Diseases of the esophagus· 0 citations
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