Long-Term Quality of Life after Hybrid Robot-assisted and Open Ivor Lewis Esophagectomy for Esophageal Cancer in a Single Center: a Comparative Analysis

Purpose: Due to improved survival of esophageal cancer patients, long-term quality of life (QoL) is increasingly gaining importance. We analyzed QoL of patients treated with open Ivor Lewis esophagectomy (Open-E) or a hybrid operation including laparotomy and a robot-assisted thoracic phase (hRob-E), as well as a standard group of healthy individuals. Methods With a median follow-up of 36 months after hRob-E (n = 28) and 40 months after Open-E (n = 43), patients´ QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and the EORTC Esophagus specific QoL questionnaire 18 (QLQ-OES18). Results Patients showed similar clinical-pathological characteristics, but hRob-E patients had significantly higher ASA scores at surgery (p < 0.001). Patients and healthy controls reported similar global health status, emotional and cognitive functions. However, physical functioning of Open-E patients was significantly reduced compared to healthy controls (p = 0.019). Operated patients reported reduced role and social functioning, fatigue, nausea and vomiting, dyspnea and diarrhea. A trend towards a better pain score after hRob-E compared to Open-E emerged (p = 0.063). Regarding QLQ-OES18, hRob-E and Open-E treated patients similarly reported eating problems, reflux, and troubles swallowing saliva. Conclusions The general health status is not impaired after esophagectomy. Despite higher ASA scores, QoL of hRob-E patients is similar to that of patients operated with Open-E. Moreover, patients after hRob-E appear to have a better score regarding physical functioning and a better pain profile than patients after Open-E, indicating a benefit of minimally invasive surgery.