J.W. van Sandick

Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life?

Purpose: To compare the validity, reliability and responsiveness of a single, global quality of life question to multi-item scales. Method: Data were obtained from 83 consecutive patients with oesophageal adenocarcinoma undergoing either transhiatal or transthoracic oesophagectomy. Quality of life was measured at baseline, 5 weeks, 3 and 12 months post-operatively with a single-item Visual Analogue Scale (VAS) ranging from 0 to 100, the multi-item Medical Outcomes Study Short Form-20 (MOS SF-20) and Rotterdam Symptom Check-List (RSCL). Convergent and discriminant validity, test–retest reliability and both distribution-based and anchor-based responsiveness were evaluated. Major findings: At baseline and at 5 weeks, the VAS showed high correlations with the MOS SF-20 health perceptions scale (r = 0.70 and 0.72) and moderate to high correlations with all other subscales of the MOS SF-20 and RSCL (r = 0.29–0.70). The test–retest reliability intra-class correlation for the VAS was 0.87. At 5 weeks post-operatively, the distribution-based responsiveness was moderate for the VAS (standardised response mean: −0.47; effect size: −0.56), high for the physical subscales of the MOS SF-20 and RSCL (−1.08 to −1.51) and low for the psychological subscales (0.11 to −0.25). Five weeks post-operatively, anchor-based responsiveness was highest for the VAS (r = 0.54). Conclusion: The VAS is an instrument with good validity, excellent reliability, moderate distribution-based responsiveness and good anchor-based responsiveness compared to multi-item questionnaires. Its use is recommended in clinical trials to assess global quality of life.

Impact of endoscopic biopsy surveillance of Barrett's oesophagus on pathological stage and clinical outcome of Barrett's carcinoma

Background—The efficacy of endoscopic biopsy surveillance of Barrett’s oesophagus in reducing mortality from oesophageal cancer has not been confirmed. Aims—To investigate the impact of endoscopic biopsy surveillance on pathological stage and clinical outcome of Barrett’s carcinoma. Methods—A clinicopathological comparison was made between patients who initially presented with oesophageal adenocarcinoma (n=54), and those in whom the cancer had been detected during surveillance of Barrett’s oesophagus (n=16). Results—The surveyed patients were known to have Barrett’s oesophagus for a median period of 42 months (range 6–144 months). Prior to the detection of adenocarcinoma or high grade dysplasia, 13 of 16 patients (81%) were previously found to have low grade dysplasia. Surgical pathology showed that surveyed patients had significantly earlier stages than non-surveyed patients (p=0.0001). Only one surveyed patient (6%) versus 34 non-surveyed patients (63%) had nodal involvement (p=0.0001). Two year survival was 85.9% for surveyed patients and 43.3% for non-surveyed patients (p=0.0029). Conclusions—The temporal course of histological progression in our surveyed patients supports the theory that adenocarcinoma in Barrett’s oesophagus develops through stages of increasing severity of dysplasia. Endoscopic biopsy surveillance of Barrett’s oesophagus permits detection of malignancy at an early and curable stage, thereby potentially reducing mortality from oesophageal adenocarcinoma.

Quality of Life After Transhiatal Compared With Extended Transthoracic Resection for Adenocarcinoma of the Esophagus

PURPOSE To assess 3 years of quality of life in patients with esophageal cancer in a randomized trial comparing limited transhiatal resection with extended transthoracic resection. PATIENTS AND METHODS Quality-of-life questionnaires were sent at baseline and at 5 weeks; 3, 6, 9, and 12 months; and 1.5, 2, 2.5, and 3 years after surgery. Physical and psychological symptoms, activity level, and global quality of life were assessed with the disease-specific Rotterdam Symptom Checklist. Generic quality of life was measured with the Medical Outcomes Study Short Form-20. RESULTS A total of 199 patients participated. Physical symptoms and activity level declined after the operation and gradually returned toward baseline within the first year (P < .01). Psychological well-being consistently improved after baseline (P < .01), whereas global quality of life showed a small initial decline followed by continuous gradual improvement (P < .01). Quality of life stabilized in the second and third year. Three months after the operation, patients in the transhiatal esophagectomy group (n = 96) reported fewer physical symptoms (P = .01) and better activity levels (P < .01) than patients in the transthoracic group (n = 103), but no differences were found at any other measurement point. For psychological symptoms and global quality of life, no differences were found at any follow-up measurement. A similar pattern was found for generic quality of life. CONCLUSION No lasting differences in quality of life of patients who underwent either transhiatal or transthoracic resection were found. Compared with baseline, quality of life declined after the operation but was restored within a year in both groups.

Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer

Surgery alone for locally advanced oesophageal cancer is associated with low cure rates. The benefits and risks of neoadjuvant chemoradiation for patients with oesophageal cancer were evaluated.

Differences in outcomes of oesophageal and gastric cancer surgery across Europe

In several European countries, centralization of oesophagogastric cancer surgery has been realized and clinical audits initiated. The present study was designed to evaluate differences in resection rates, outcomes and annual hospital volumes between these countries, and to analyse the relationship between hospital volume and outcomes.

Surveillance of Barrett's oesophagus: physicians' practices and review of current guidelines.

Background Endoscopic biopsy surveillance of Barretts oesophagus is generally recommended. However, optimal patient selection and frequency of follow‐up are subject to ongoing discussion. Objective To investigate current surveillance practices for Barretts oesophagus in the Netherlands and to explore their concordance with the guidelines for Barretts oesophagus surveillance as recommended by the International Society for Diseases of the Esophagus (ISDE). Methods An anonymous questionnaire was mailed to 269 specialist physicians working in the field of gastroenterology. Results The response rate was 88% (238/269). Most of the respondents (84%) performed regular endoscopic follow‐up of Barretts oesophagus. In 52%, endoscopic biopsy sampling corresponded to the ISDE guidelines (four‐quadrant biopsies at 2 cm intervals). Agreement was 60% regarding the interval of surveillance for no dysplasia (every 2 years), 52% regarding the interval for low‐grade dysplasia (every year) and 54% for management of high‐grade dysplasia (oesophagectomy if diagnosis confirmed by a second pathologist or re‐biopsy in the short term). When combining these three items, consistency with the ISDE guidelines decreased to 25%. Criteria to select patients for surveillance included age, presence of symptoms, length of Barretts oesophagus and type of Barrett epithelium. Conclusions The survey indicates widespread practice of cancer surveillance for patients with Barretts oesophagus in the Netherlands. However, there is limited uniformity in the frequency and intensity of endoscopic histological follow‐up. This variability in clinical practice may result from conflicting data and recommendations in the literature. Updated consensus is needed in this area. Eur J Gastroenterol Hepatol 12:111‐117

Early outcomes from the Dutch Upper Gastrointestinal Cancer Audit

In 2011, the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group began nationwide registration of all patients undergoing surgery with the intention of resection for oesophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of this process along with an overview of the results.

Influence of hospital type on outcomes after oesophageal and gastric cancer surgery

Outcomes after oesophagectomy and gastrectomy vary considerably between hospitals. Possible explanations include differences in case mix, hospital volume and hospital type. The present study examined the distribution of oesophagectomies and gastrectomies between hospital types in the Netherlands, and the relationship between hospital type and outcome.

Quality-of-care indicators for oesophageal cancer surgery: A review

BACKGROUND Quality-of-care indicators are measurable elements of practice performance that can assess the (change in) quality of the care provided. To date, the literature on quality-of-care indicators for oesophageal cancer surgery has not been reviewed. METHODS We performed a review of the literature on quality-of-care indicators for oesophageal cancer surgery. The indicators were classified by their nature of care provision (structural, process, or outcome). RESULTS One hundred thirty articles were included. For structural measures, most evidence was found for the inverse relationship between hospital or surgeon volume and post-operative mortality. Few articles described the required infrastructural and organisational elements for oesophageal cancer surgery. Regarding process measures, the most common indicators were determinants of patient selection for surgery. Other process indicators with considerable evidence were found (e.g., multidisciplinary team management), though the number of studies was small. For outcome indicators, the level of evidence for pathological outcome measures was strong. Data on post-operative complications as outcome indicators varied widely. CONCLUSION Since there is considerable variation in the evaluation of quality of care, the uniform use of well-defined quality-of-care indicators to measure and document practice performance holds the promise of improving outcome in patients who undergo oesophageal cancer surgery.

Symptomatic mucocele of a surgically excluded esophagus

SUMMARY. Isolated esophageal segments following esophageal bypass surgery may develop into mucus-filled dilatations (mucoceles) of the esophagus. They usually remain small and asymptomatic. This report describes a patient who developed a symptomatic esophageal mucocele 1 year after surgical exclusion of the thoracic esophagus for Boerhaaves syndrome.