La chirurgie du cancer oesophagien à Liège: III. Evaluation clinique et radiographique de la qualité de vie à long terme après oesophagectomie

OBJECTIVE: Functional evaluation of digestive transplants after oesophagectomy for cancer. MATERIAL AND METHODS: We evaluated alimentary comfort and quality of life and performed a videofluoroscopy (radiocinema) in 34 patients who were alive and disease-free one year or more after oesophagectomy for malignancy. There were 22 males and 12 females; mean age was 64 years. Twenty-three patients had a gastric pull-up and 11 a colonic graft. Mean follow-up was 36 months (range: 12-100 months). Possible correlations between clinical symptoms and radiographic observations were studied with Fisher's exact test. RESULTS: Most-cited symptoms were gurgling in 16 patients, early fullness during eating in 15, diarrhea in 14, postprandial sweating in 9, pyrosis in 8, nocturnal cough in 7, and dysphagia in 5. Most patients considered the side effects of the operation as mild to moderate and mean rating of alimentary comfort was 7.6/10. Twenty-five patients qualified their quality of life as good, 8 as satisfactory, and 1 as poor. Twenty-nine patients led active lives. Videofluoroscopic evaluation showed that colonic grafts emptied mainly by gravity, while active contractions were observed in the antrum of gastric transplants. There was a significant correlation between alimentary symptoms and radiographic distension of the transplant. Oro-pharyngeal abnormalities, site of proximal anastomosis, nature, motility, or active versus passive emptying of the transplant did not correlate with clinical complaints. CONCLUSIONS: In most patients quality of life and alimentary comfort are good after oesophagectomy and gastric or colonic interposition. Radiocinema is an adequate method to evaluate the dynamic of the transplant and shows a better emptying of gastric grafts, compared to colonic grafts, particularly when the proximal portion of the oesophagus triggers the progression.