Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 225–231 | Cite as

Comparison of Long-term Quality of Life in Patients with Esophageal Cancer after Ivor-Lewis, Mckeown, or Sweet Esophagectomy

  • Yu-Shang Yang
  • Qi-Xin Shang
  • Yong YuanEmail author
  • Xiao-Ying Wu
  • Wei-Peng Hu
  • Long-Qi Chen
Original Article



The aim of this study was to compare the long-term quality of life (QoL) in patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy.


Esophageal cancer patients after Sweet, Ivor-Lewis, or Mckeown esophagectomy from 2010 to 2012 were included. QoL was assessed according to the European Organization for Research and Treatment of Cancer general questionnaire: QLQ-C30 and esophagus-specific questionnaire: QLQ-OES18.


A total of 126 qualified patients who have been alive for more than 3 years without tumor recurrence were divided into three groups: the Sweet group (n = 40), Ivor-Lewis group (n = 38), and Mckeown group (n = 48). Among these three groups, the QLQ-C30 mean scores of global health status, functional and symptom scales, and general QoL were similar. The symptom scales of QLQ-OSE18 showed that patients who had a Mckeown operation experienced more problem of eating (P = 0.029), choking when swallowing (P = 0.010) and coughing (P = 0.016), while patients undergoing Sweet operation complained more symptom of reflux (P = 0.003) and pain (P = 0.000).


All three types of esophagectomy provided a generally good long-term QoL. However, patients in Sweet and Mckeown group tend to suffer from a higher symptomatic burden as compared to Ivor-Lewis approach.


Esophageal cancer Quality of life (QoL) QLQ-C30 QLQ-OES18 Esophagectomy 


Authors’ Contributions

(I) Conception and design: Long-Qi Chen, Yu-Shang Yang, and Yong Yuan;

(II) Administrative support: Wei-Peng Hu and Yu-Shang Yang;

(III) Provision of study materials or patients: Qi-Xin Shang and Yu-Shang Yang;

(IV) Collection and assembly of data: Yu-Shang Yang, Xiao-Ying Wu, and Qi-Xin Shang;

(V) Data analysis and interpretation: Qi-Xin Shang, Wei-Peng Hu, and Yong Yuan;

(VI) Manuscript writing: All authors;

(VII) Final approval of manuscript: All authors.

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.


  1. 1.
    Lagergren J, Smyth E, Cunningham D, and Lagergren P. Oesophageal cancer. Lancet 2017; 390: 2383–2396.CrossRefGoogle Scholar
  2. 2.
    Huang HT, Wang F, Shen L, Xia CQ, Lu CX, and Zhong CJ. Clinical Outcome of Middle Thoracic Esophageal Cancer with Intrathoracic or Cervical Anastomosis. Thorac Cardiovasc Surg 2015; 63: 328–34.CrossRefGoogle Scholar
  3. 3.
    Noordman BJ, Wijnhoven BP, and van Lanschot JJ. Optimal surgical approach for esophageal cancer in the era of minimally invasive esophagectomy and neoadjuvant therapy. Dis Esophagus 2016; 29: 773–779.CrossRefGoogle Scholar
  4. 4.
    Wang ZQ, Wang WP, Yuan Y, Hu Y, Peng J, Wang YC, et al. Left thoracotomy for middle or lower thoracic esophageal carcinoma: still Sweet enough?. J Thorac Dis 2016; 8: 3187–3196.CrossRefGoogle Scholar
  5. 5.
    Ma J, Zhan C, Wang L, Jiang W, Zhang Y, Shi Y, et al. The sweet approach is still worthwhile in modern esophagectomy. Ann Thorac Surg 2014; 97: 1728–33.CrossRefGoogle Scholar
  6. 6.
    Deschamps C, Nichols FC, 3rd, Cassivi SD, Allen MS, and Pairolero PC. Long-term function and quality of life after esophageal resection for cancer and Barrett's. Surg Clin North Am 2005; 85: 649–56, xi.CrossRefGoogle Scholar
  7. 7.
    Courrech Staal EF, van Sandick JW, van Tinteren H, Cats A, and Aaronson NK. Health-related quality of life in long-term esophageal cancer survivors after potentially curative treatment. J Thorac Cardiovasc Surg 2010; 140: 777–83.CrossRefGoogle Scholar
  8. 8.
    McLarty AJ, Deschamps C, Trastek VF, Allen MS, Pairolero PC, and Harmsen WS. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 1997; 63: 1568–72.CrossRefGoogle Scholar
  9. 9.
    Schmidt CE, Bestmann B, Kuchler T, Schmid A, and Kremer B. Quality of life associated with surgery for esophageal cancer: differences between collar and intrathoracic anastomoses. World J Surg 2004; 28: 355–60.CrossRefGoogle Scholar
  10. 10.
    Blazeby JM, Farndon JR, Donovan J, and Alderson D. A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 2000; 88: 1781–7.CrossRefGoogle Scholar
  11. 11.
    Viklund P, Wengstrom Y, Rouvelas I, Lindblad M, and Lagergren J. Quality of life and persisting symptoms after oesophageal cancer surgery. Eur J Cancer 2006; 42: 1407–14.CrossRefGoogle Scholar
  12. 12.
    Avery KN, Metcalfe C, Barham CP, Alderson D, Falk SJ, and Blazeby JM. Quality of life during potentially curative treatment for locally advanced oesophageal cancer. Br J Surg 2007; 94: 1369–76.CrossRefGoogle Scholar
  13. 13.
    Donohoe CL, McGillycuddy E, and Reynolds JV. Long-term health-related quality of life for disease-free esophageal cancer patients. World J Surg 2011; 35: 1853–60.CrossRefGoogle Scholar
  14. 14.
    Gutschow CA, Holscher AH, Leers J, Fuchs H, Bludau M, Prenzel KL, et al. Health-related quality of life after Ivor Lewis esophagectomy. Langenbecks Arch Surg 2013; 398: 231–7.CrossRefGoogle Scholar
  15. 15.
    Edge SB and Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17: 1471–4.CrossRefGoogle Scholar
  16. 16.
    Fayers P, Aaronson NK, Bjordal K, Grønvold M, Curran D, and Bottomley A. EORTC QLQ-C30 Scoring Manual (3rd edition). 2001;Google Scholar
  17. 17.
    Blazeby JM, Alderson D, Winstone K, Steyn R, Hammerlid E, Arraras J, et al. Development of an EORTC questionnaire module to be used in quality of life assessment for patients with oesophageal cancer. The EORTC Quality of Life Study Group. Eur J Cancer 1996; 32A: 1912–7.CrossRefGoogle Scholar
  18. 18.
    Blazeby JM, Conroy T, Hammerlid E, Fayers P, Sezer O, Koller M, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer 2003; 39: 1384–94.CrossRefGoogle Scholar
  19. 19.
    Scott NW, Fayers P, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, et al. EORTC QLQ-C30 reference values manual. 2008;Google Scholar
  20. 20.
    Derogar M and Lagergren P. Health-related quality of life among 5-year survivors of esophageal cancer surgery: a prospective population-based study. J Clin Oncol 2012; 30: 413–8.CrossRefGoogle Scholar
  21. 21.
    Wormald JC, Bennett J, van Leuven M, and Lewis MP. Does the site of anastomosis for esophagectomy affect long-term quality of life?. Dis Esophagus 2016; 29: 93–8.CrossRefGoogle Scholar
  22. 22.
    Egberts JH, Schniewind B, Bestmann B, Schafmayer C, Egberts F, Faendrich F, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life--a prospective, longitudinal outcome study. Ann Surg Oncol 2008; 15: 566–75.CrossRefGoogle Scholar
  23. 23.
    Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH, Jr., et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78: 1170–6; discussion 1170–6.Google Scholar
  24. 24.
    Raymond DP, Seder CW, Wright CD, Magee MJ, Kosinski AS, Cassivi SD, et al. Predictors of Major Morbidity or Mortality After Resection for Esophageal Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model. Ann Thorac Surg 2016; 102: 207–14.CrossRefGoogle Scholar
  25. 25.
    Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB, et al. International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 2015; 262: 286–94.CrossRefGoogle Scholar
  26. 26.
    Daster S, Soysal SD, Stoll L, Peterli R, von Flue M, and Ackermann C. Long-term quality of life after Ivor Lewis esophagectomy for esophageal cancer. World J Surg 2014; 38: 2345–51.CrossRefGoogle Scholar
  27. 27.
    Pennathur A, Zhang J, Chen H, and Luketich JD. The “best operation” for esophageal cancer?. Ann Thorac Surg 2010; 89: S2163–7.CrossRefGoogle Scholar
  28. 28.
    Yamamoto S, Makuuchi H, Shimada H, Chino O, Nishi T, Kise Y, et al. Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction. J Gastroenterol 2007; 42: 342–5.CrossRefGoogle Scholar
  29. 29.
    Yajima K, Kosugi S, Kanda T, Matsuki A, and Hatakeyama K. Risk factors of reflux esophagitis in the cervical remnant following esophagectomy with gastric tube reconstruction. World J Surg 2009; 33: 284–9.CrossRefGoogle Scholar
  30. 30.
    Sato Y, Kosugi S, Aizawa N, Ishikawa T, Kano Y, Ichikawa H, et al. Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma. World J Surg 2016; 40: 129–36.CrossRefGoogle Scholar
  31. 31.
    van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, and van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg 2010; 251: 1064–9.CrossRefGoogle Scholar
  32. 32.
    Pennathur A LR, Villa Sanchez M, Schuchert MJ, Awais O, Ward J, Gooding WE, Landreneau RJ, Dhupar R, Sarkaria I, Christie NA, Luketich JD. Prospective Study of Quality of Life after Esophagectomy with a Focus on Minimally Invasive Esophagectomy. American Association for Thoracic Surgery Annual Meeting 2018; San Diego, CA. April 2018Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Yu-Shang Yang
    • 1
  • Qi-Xin Shang
    • 1
  • Yong Yuan
    • 1
    Email author
  • Xiao-Ying Wu
    • 1
  • Wei-Peng Hu
    • 1
  • Long-Qi Chen
    • 1
  1. 1.Department of Thoracic SurgeryWest China Hospital of Sichuan UniversityChengduChina

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