Predictors of postoperative health-related quality of life in patients with esophageal cancer: a scoping review.

Esophagectomy for esophageal cancer significantly impacts health-related quality of life. Identification of these predictors could enable early risk stratification and guide supportive care strategies preoperatively and immediately postoperatively. We aimed to systematically map preoperative and surgical factors associated with postoperative health-related quality of life in patients undergoing esophagectomy for esophageal cancer. MEDLINE, CENTRAL, EMBASE and Web of Science were searched through November 2024. We included cohort and case-control studies examining preoperative and surgical factors affecting postoperative health-related quality of life. Nine studies (2285 patients) from Asia and Europe (2013-2021) met the inclusion criteria. EORTC QLQ-C30 questionnaires were used in all studies. Eight factors showed significant associations with postoperative health-related quality of life in multivariate analysis: age, sex, sarcopenia, tumor location, neoadjuvant therapy (NAT), surgical approach (open versus minimally invasive; transthoracic versus transhiatal), circumferential margin status, and systemic immune-inflammation index. Temporal analysis revealed distinct patterns: early postoperative health-related quality of life (≤ 6 months) was influenced by age, sex, sarcopenia, tumor location, NAT and margin status. In contrast, late health-related quality of life (> 6 months) was associated with age, sex, NAT, surgical approach, and systemic immune-inflammation index.Multiple preoperative and surgical predictors of health-related quality of life after esophagectomy were identified, with distinct factors affecting between the first ≤6 postoperative months and subsequently. These findings emphasize the importance of systematically assessing preoperative and surgical factors when developing supportive care strategies.