C.E. Cox1,3, M. O’Leary1, E. Kwong4, G. Mody1 1University Of North Carolina At Chapel Hill, Surgery, Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill, Urology, Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA 4University Of North Carolina At Chapel Hill, Carolina Health Informatics Program, Chapel Hill, NC, USA 5University Of North Carolina At Chapel Hill, Radiation Oncology, Chapel Hill, NC, USA
Introduction:
The only definitive cure for esophageal cancer is resection. However, esophagectomy is a morbid procedure with high complication rates and a significant impact on quality of life (QOL). The objective of this review is to determine the effect of esophagectomy on long-term QOL in patients with esophageal cancer.
Methods:
This protocol was developed in accordance with the PRISMA-P guidelines. Prospective studies including adults (18 and over) with esophageal cancer of any type who underwent esophagectomy with curative intent will be included. Studies will have measured QOL at least 1 year from surgery and will be published in English. Only studies utilizing accepted instruments for measuring QOL will be included at full-text review. An a priori list of expected instruments includes EORTC QLQ-C-30 and/or LC-13, FACT-G, SF-36, and SF-4a. Baseline QOL (if obtained) and QOL at any time points from 1 year and beyond with all accepted instruments utilized will be abstracted as well as demographic features including: age, sex, race, cancer type, and Charleson Comorbidity Index. Country of origin will be collected as well as study design, minimally invasive or open procedure, and number of participants. Risk of bias will be assessed by two independent reviewers using the Agency for Healthcare and Research Quality Risk of Bias Tool. Quality of evidence will be assessed using the LEGEND evidence appraisal tools. Effect measures will include overall QOL, QOL difference from baseline (if baseline obtained), and time to return to baseline (if baseline obtained). Meta-analysis of effect estimates will be utilized to describe all 3 outcomes. Studies with >50% missingness in overall QOL or baseline QOL will be excluded from those analyses. Studies with >10% missingness in baseline or overall QOL will be excluded from time-to-event analysis for return to baseline. Funnel plots will be utilized to assess for selective reporting bias. Exploratory analysis of minimally invasive vs. open procedures will be conducted.
Conclusion:
In recent years there has been a growing emphasis on the collection and analysis of quality of life data from cancer patients undergoing surgery. Several systematic reviews have been published on QOL from esophageal cancer, however, the majority of previously published studies included only short term follow up extending up to approximately 1 year after surgery. Given the proliferation of QOL data in recent years an increasing number of studies containing data on QOL extending beyond the first year after surgery have been published. Thus, it is an optimal time to provide a systematic review with emphasis on the long term QOL outcomes from esophagectomy.