Comparison of QoL Between Substernal and Posterior Mediastinal Routes in Esophagogastrostomy

Background After esophagectomy, various reconstruction routes can be considered for technical and oncologic objectives. The substernal route is believed to cause more dysphagia or delayed gastric emptying symptoms than the posterior mediastinal route. We evaluated and compared the quality of life (QoL) after reconstruction by either the substernal or posterior mediastinal routes in the McKeown procedure. Methods Between 2011 and 2018, 378 patients who received an esophagectomy and cervical esophagogastrostomy for esophageal cancer were followed up. Among these patients, 278 received reconstruction via the substernal route and 100 via the posterior mediastinal route. Patients completed the validated questionnaires, EORTC QLQ-C30 and QLQ-OES18, before surgery and at 1, 2, 3, 6, 12, and 24 months after surgery. Linear mixed-effects models were used to examine changes in questionnaire scores over time. Results One month after surgery, patients QoL deteriorated and more symptoms were observed than at baseline. Global health status, nausea and vomiting, and esophageal pain gradually recovered from 2 months and recovered to initial levels at 2 years. However, the other functional and symptom scales of the QLQ-C30 and OES18 were not normalized at 2 years after the operation. When comparing the substernal and posterior mediastinal routes, QLQ-OES18 symptom scales, such as eating, dysphagia, trouble with swallowing saliva trouble with taste and reflux, were no different between the two groups, even after adjusting confounding factors at 2 years after the operation. Conclusion The cervical esophagogastrostomy with a substernal route showed comparable QoL to reconstruction with a posterior mediastinal route.