A Prospective Longitudinal Study Examing The Impact Of Fast Track Surgery Program On Short Term Quality Of Life After Esophagectomy In Esophageal Cancer Patients

Background and ObjectiveEsophageal cancer is one of the most common gastrointestinal malignancy in ourcountry. Although the terms of the diagnosis, surgical treatment of esophageal cancerand neoadjuvant chemotherapy have got development, Prognosis for esophagealcancer is still poor, and the5-year survival rate is only5%-15%. Despite a significantdecline (5%-25%) in mortality rates after esophagectomy over the last two decades,postoperative morbidity still remains high, ranging form45%to80%. With thepopularization and application of thoracoscopic techniques in the field of thoracicsurgery, thoracolaparoscopic esophagectomy has got developed, and it is has someadvantages including that maintain the integrity of the thorax and abdomen, reducetrauma, keep little impact on respiratory function, reduce postoperative pain, recoverfaster, reduce postoperative respiratory complications, and lymph node dissectionperformed more clear and comply with the principles of oncology.Fast track surgery(FTS） concept refers to through the multidisciplinarycollaboration to reduce surgical stress, reduce perioperative organs dysfunction, andfurther reduce postoperative complications with shorter hospitalization days, so as toachieve the purpose of rapid rehabilitation. FTS, which main include minimally invasive surgery, early postoperative oral intake, early postoperative ambulation,postoperative analgesia and so on.With the development of economy and life standards of people, Besidesmorbidity, mortality and survival, the quality of life (QOL) is also accepted as anadditional outcome parameter in patients undergoing oncologic surgery. Therefore,the main objective of this study is to to evaluate the impact on the short-term qualityof life of fast track surgery program(FTS) in thoracoscopic/laparoscopicesophagectomy.MethodsFrom April2013to October2013,67patients underwent the FTS pathway,71patients underwent the conventional rehabilitation(CR) pathway. To assess the QOL,a questionnaire in reference to the EORTC QLQ-C30and the QLQ-OES18wasadministered at one week before operation, one week, two weeks, four weeks,eightweeks and twelve weeks after surgery. Clinical data was collected in the perioperativeperiod.ResultsThere were no significant differences between the FTS pathway group (n=67)and the conventional rehabilitation pathway group (n=71) with regard to patient andcancer characteristics, operation time, the cases at intensive care unit (ICU)postoperatively. Preoperative functional and symptom QOL mean scores have nosignificant differences between the two groups. Statistically significant differenceswere seen in the blood loss [FTS:(48.8±18.7)ml vs. CR:(241.3±109.6)ml, P<0.05],thedays of chest tube removal [FTS:(1.5±0.9)days vs. CR:(7.2±2.8)days, P<0.05], thedays of oral intake [FTS:(1.5±1.5)days vs. CR:(8.0±2.9)days, P<0.05], the rate ofpostoperative pulmonary complications (FTS:2.9%vs. CR:15.5%,P=0.01) andpostoperative hospital stay [FTS:(7.8±1.8)days vs. CR:(14.3±2.0)days, P<0.05]between the FTS group and the conventional rehabilitation(CR) group. FTS groupgains higher score in physical functioning, global QOL from1week to12weeks postoperation(all P<0.05) and also got higher score role functioning, emotionalfunctioning(all P<0.05); lower scores in pain, fatigue, eating, dysphagia symptomsthan those in conventional rehabilitation pathway group from1week to8weeks aftersurgery (all P<0.05). Moreover, patients’ QOL scores of FTS group recover topreoperative levels more quickly than those patients in conventional rehabilitationpathway group.ConclusionsCompared to conventional rehabilitation program，fast track surgery programwhich could improve patients’ short-term quality of life significantly,and also reducethe postoperative hospital stays.