Background 

Approximately 30% of patients suffer from severe reflux after surgery for esophageal cancer, which may serve as a continuous reminder of the cancer and catalyze fear of recurrence.

Objective 

The aim of this study was to investigate the association between severe reflux and symptoms of anxiety and depression after esophageal cancer surgery.

Methods 

This was a nationwide prospective cohort study including all Swedish patients who underwent esophageal cancer surgery between 2013 and 2018. Patients reported reflux on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms and psychological distress on the Hospital Anxiety and Depression Scale at 1 and 2 years after surgery. Repeated-measures logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, body mass index, TNM classification, neoadjuvant therapy, surgery type, postoperative complications, antireflux medication, and elevated headrest at night.

Results 

Among 154 included patients, 43 (28%) and 37 (24%) reported severe reflux 1 and 2 years after surgery, respectively. No association between severe reflux and anxiety (OR, 2.1; 95% CI, 0.7–6.3) or depression (OR, 1.2; 95% CI, 0.3–4.6) was found 1 year after surgery. After 2 years, there was still no association between severe reflux and anxiety (OR, 0.9; 95% CI, 0.3–2.8) or depression (OR, 1.2; 95% CI, 0.5–3.3).

Conclusions 

Findings suggest that severe reflux is not associated with anxiety or depression after esophageal cancer surgery.

Implications for Practice 

For esophageal cancer survivors, other factors than severe reflux may be more important for the psychological recovery.

中文翻译：

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食管癌手术后的严重反流和焦虑抑郁症状

背景 

大约 30% 的患者在食管癌手术后会出现严重的反流，这可能会持续提醒癌症并引发对复发的恐惧。

客观的 

本研究的目的是调查食管癌手术后严重反流与焦虑和抑郁症状之间的关系。

方法 

这是一项全国性前瞻性队列研究，包括所有在 2013 年至 2018 年间接受食管癌手术的瑞典患者。患者在欧洲癌症研究和治疗组织的胃食管症状和医院焦虑和心理困扰的生活质量问卷模块中报告了反流。术后 1 年和 2 年的抑郁量表。重复测量逻辑回归用于计算优势比 (OR) 和 95% 置信区间 (CI)，调整了年龄、性别、合并症、体重指数、TNM 分类、新辅助治疗、手术类型、术后并发症、抗反流药物、和夜间升高的头枕。

结果 

在纳入的 154 名患者中，分别有 43 名（28%）和 37 名（24%）在术后 1 年和 2 年报告了严重的反流。术后 1 年未发现严重反流与焦虑（OR，2.1；95% CI，0.7-6.3）或抑郁（OR，1.2；95% CI，0.3-4.6）之间存在关联。2 年后，严重反流与焦虑（OR，0.9；95% CI，0.3-2.8）或抑郁（OR，1.2；95% CI，0.5-3.3）之间仍然没有关联。

结论 

研究结果表明，食管癌手术后严重反流与焦虑或抑郁无关。

对实践的启示 

对于食管癌幸存者来说，严重反流以外的其他因素可能对心理恢复更为重要。