Maarten van Egmond

46 Chapter 3 RESULTS Aspects of functional status were assessed of 155 patients with an indication for esophagectomy at T1 and T2 (100%), of which 109 patients were assessed at T3 (70.3%) and 60 at T4 (38.7%). The mean age at surgery was (SD) 63.5 years (9.3), and 122 patients (78.7%) were male. Pulmonary function was better than predicted with a forced vital capacity of (mean, [SD]) 114.4 [16.6], forced expiratory volume in 1 second of 107.4 [19.0] and inspiratory vital capacity of 110.4 [16.3]. All patients received neoadjuvant therapy. The majority of patients (72.3%) underwent a minimally invasive transthoracic esophagectomy. Table 1 presents all patient characteristics at the different time points. One week after surgery (T3), 46 patients could not be assessed for functional status due to postoperative complications (12.9%), refusal to further cooperate (5.8%) or feeling too weak to be assessed (3.2%). See Table 2 for further details. At T4 (3 months postoperatively), another 49 patients were not able to be assessed due to loss to follow-up (20.2%), the presence of complications (5.5%), the inability to be assessed due to sickness (5.5%) and refusal to further cooperate (6.4%). A detailed analysis of the patients who were lost to follow-up at T3 and T4 revealed that these patients did not systematically differ in baseline characteristics from the patients who completed all measurements but the proportion of patients lost to follow up at T3 with a postoperative complication Clavien-Dindo grade 3a, 4a and 4b was higher (Table 1). The mean level of HGS, proximal muscle strength of the lower extremities and MIP before surgery (T1 and T2) was higher than predicted when adjusted for sex and age. From T1 to T2 walking capacity, HRQL, and ADL significantly improved and patients experienced significantly less fatigue. At T3, proximal muscle strength of the lower extremities and MIP were significantly decreased compared to T2, whereas HGS remained more or less unchanged. At T4, all mean functional status measures returned to baseline levels, but patients had significantly less HGS and experienced more fatigue (Table 3). Figure 1 shows the graphical representation of the course of measurements of functional status over time. The incidence of postoperative complications was 83 (53.5%) and was registered as one or more postoperative complications per patient, and this group had a significantly longer hospital stay with a median (IQR) of 17 (9 to 30) days ( P ≤ .01) (Figure 2). No differences in the measurements of functional status between patients with and without complications at the different time points (Table 4) were observed, apart from 2MWT at T3, which was significantly lower in the group with postoperative complications.