***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aims of this prospect i ve study were to analyze the predictors of postoperative sleep disturbance after esophagectomy for cancer and to identify patients at risk for postoperative hypnotic administration . Methods Sixty two consecutive patients who underwent cancer-related esophagectomy were enrolled in this study from May 2011 to February 2012 . Data about perioperative management , postoperative complications , ICU stay , and vasopressor , hypnotic , and painkiller administration were retrieved . The EORTC QLQ-C30 was used and global quality of life ( QL2 item ) and sleep disturbance ( SL item ) were the primary endpoints . Univariate and multivariate analyses were performed . Results Postoperative request of hypnotics independently predicted bad quality of life outcome . Sleep disturbance after esophagectomy was independently predicted by the duration of dopamine infusion in the ICU and the daily request of benzodiazepines . Even in this case , only sleep disturbance at diagnosis revealed to be an independent predictor of hypnotic administration need . ROC curve analysis showed that sleep disturbance at diagnosis was a good predictor of  benzodiazepine request ( AUC = 73 % , P = 0.02 ) . Conclusions The use of vasopressors in the ICU affects sleep in the following postoperative period and the use of hypnotics is neither completely successful nor lacking in possible consequences . Sleep disturbance at diagnosis can successfully predict patients who can develop sleep disturbance during the postoperative period Background In patients with esophageal cancer , evidence for prognostic significance of preoperative  quality of life ( QoL ) is limited , while the prognostic significance of postoperative QoL has not been investigated at all . Aim To determine whether preoperative and postoperative QoL measurements can predict survival independently from clinical and pathological factors , in patients with potentially curable esophageal adenocarcinoma . Methods A r and omized controlled trial was performed from 1994 to 2000 in two academic medical centres , comparing transthoracic and transhiatal esophagectomy . QoL question naires were sent before and 3 months after surgery ( Medical Outcome Study Short Form-20 and Rotterdam Symptom Checklist ) . Uni- and multivariate Cox regression analyses were used to examine firstly the prognostic value of preoperative QoL and several clinical factors , and secondly of postoperative QoL , several clinical factors , and pathological staging . Results Out of 220 r and omized patients , 199 participated in the QoL- study . In the multivariate preoperative model physical symptom scale ( p = 0.021 ) , tumor length ( p = 0.034 ) , and endosonographic T-stage ( p = 0.003 ) were predictive for overall survival . In the postoperative multivariate analysis , social functioning ( p = 0.035 ) , pain ( p = 0.026 ) , and activity level ( p = 0.037 ) predicted survival , besides pathological T-stage ( p < 0.001 ) and N-stage ( p < 0.001 ) . Conclusion In the present paper the first large consecutive series of potentially curable esophageal cancer patients is presented in whom prospect ively collected QoL data before and after potentially curative surgical resection were used to predict survival . Both preoperative ( physical symptoms ) and postoperative ( social functioning , pain , and activity level ) QoL subscales are independent predictors of survival in potentially curable patients with esophageal adenocarcinoma Background For patients undergoing oncologic surgery  , the quality of life ( QoL ) is generally accepted as an important outcome parameter in addition to long-term survival , mortality , and complication rates . Our study focused on outcome in terms of QoL in patients with esophageal cancer , comparing the sites of anastomosis ( cervical versus thoracic anastomosis ) . Methods In a prospect i ve longitudinal single-center study from 1998 to 2005 , 105 patients underwent surgery for esophageal cancer . To assess QoL the EORTC-QLQ-C-30 and a tumor-specific module were administered before surgery , at discharge , and three , six , 12 , and 24 months after surgery . Clinical data were collected prospect ively and follow-up was performed every six months . Results The histological type was squamous cell carcinoma in 51.4 % of the cases , adenocarcinoma in 41.9 % , and some other type in 6.7 % . There was no significant difference between cervical and thoracic anastomosis with regard to morbidity , mortality , and survival rates ( 30 % five-year survival rate ) , whereas tumor stage was a significant ( p < 0.001 ) prognostic factor . Most QoL scores dropped significantly below baseline in the early postoperative period . Even though they recovered slowly during the follow-up period , they never reached preoperative levels again . There was no statistically significant difference in any of the QoL scales between patients with a cervical or a thoracic anastomosis . Conclusions Esophageal resections are associated with significant deterioration of QoL , which persists during the follow-up period . The surgical technique and position of the esophagogastrostomy did not affect QoL deterioration Although several studies have reported the impact of oesophagectomy on health-related quality of life ( HRQOL ) , none has objective ly assessed its impact on physical fitness . This study aim ed to evaluate the impact of oesophagectomy on physical fitness and HRQOL in patients with oesophageal cancer . In this prospect i ve study , we investigated 30 consecutive patients with newly diagnosed resectable oesophageal cancer who were scheduled to receive either neoadjuvant chemotherapy followed by surgery or surgery alone .  The primary end-points were change from baseline in two measures of physical fitness ( knee-extensor muscle strength and 6-min walking distance ) after oesophagectomy . The secondary end-point was change from baseline in HRQOL measured with the European Organization for the Research and Treatment of Cancer Quality of Life Core Question naire with 30 items ( EORTC QLQ-C30 ) . Physical fitness was significantly lower after oesophagectomy than before oesophagectomy ( P < 0.001 ) . With regard to HRQOL , there was a significant pre- to post-oesophagectomy change in most of the scales . In the multiple regression analysis , the change in 6-min walking distance was the only significant variable affecting the change in physical functional score on the EORTC QLQ-C30 ( P = 0.032 ) . In conclusion , oesophagectomy adversely affects physical fitness and HRQOL in patients with oesophageal cancer .  Six-minute walking distance may be a good indicator of HRQOL shortly after oesophagectomy Objective : The aim of this study was to compare the 2-year functional performance and quality of life in patients with operable squamous cell carcinoma of the esophagus , who have received either surgery or definitive chemoradiation ( CRT ) .  Summary Background Data : The functional outcomes and quality of life in patients receiving esophagectomy or definitive CRT  is uncertain . Methods : Data were extracted from the data base of a prospect i ve r and omized controlled trial that included patients with resectable mid or lower thoracic esophageal cancers . The patients were r and omized to either st and ard esophagectomy or definitive CRT .  Quality of life assessment s were performed using the EORTC QLQ-C30 and QLQ-OES24 modules . Other functional assessment s included pulmonary and eating functions . Results : From July 2000 to December 2004 , a total of 81 patients were enrolled into the study . No significant longitudinal changes were detected in the global health status in both groups upon available follow-up . Surgery was associated with worsened physical functioning and fatigue symptoms up to 6 months after treatment ( P < 0.001 and P = 0.021 , respectively ) and these scales improved at 2 years . In terms of pulmonary function , dyspnoic and coughing symptoms were significantly worsened 3 months after surgery ( P = 0.024 and P = 0.036 , respectively ) whereas symptoms in the CRT group progressively deteriorated over time . Concerning the eating function , both groups had improvements in dysphagia but there were frequent need for endoscopic intervention . This study has been registered with clinical trials.gov and the clinical trials.gov ID number is NCT01032967 . Conclusion : Neither surgery nor definitive CRT significantly impaired the global health status of patients . Surgery was associated with a short-term negative impact in some aspects of health related quality of life assessment s but these changes became insignificant 2 years after treatment . However , CRT was associated with progressive deteriorations in pulmonary function in the longer term PURPOSE To assess 3 years of quality of life in patients with esophageal cancer in a r and omized trial comparing limited transhiatal resection with extended transthoracic resection . PATIENTS AND METHODS  Quality -of-life question naires 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 Purpose Improving survival after esophagectomy is an important issue in treating patients with esophageal cancer ( EC ) . In addition to st and ard hospitalization management , periodic assessment of quality -of-life ( QOL ) measures  may be useful to detect disease progression from patients ’ subjective reports . Therefore , this prospect i ve longitudinal study was undertaken to identify prognostic factors for 3-year survival of EC patients after esophagectomy and to evaluate the impact of QOL measures on these prognostic factors . Methods Patients with EC ( n = 67 ) who had a complete tumor resection and were alive 6 months after esophagectomy were followed in this study for 3 years . Data were collected on patients ’ sociodemographics , cancer characteristics , adjuvant therapy , general QOL and EC-specific QOL  ( before esophagectomy and 6 months afterward ) , cancer recurrence , and death . Patients ’ independent risk factors for 3-year survival were investigated by multivariate Cox regression analysis . Results Of the 67 participants with EC , 26 had late mortality  , with a median survival for the whole cohort of 38.2 months ( 95 % CI 31.97–44.35 ) . Independent predictors of early death were early cancer recurrence ( within 6 months after surgery ) , poor cognitive function ( 95 % CI 1.020–1.041 ) , and worse dyspnea ( 95 % CI 1.007–1.034 ) . Conclusions The most predictive factor for early death in EC patients after esophagectomy was cancer recurrence within 6 months after surgery . However ,  QOL measures  could be a tool to provide clinical information from patients ’ perspective suggesting cancer recurrence Health‐related quality of life ( HRQL ) outcomes are important in assessing new approaches to the treatment of cancer . Neoadjuvant therapy is being used increasingly before surgery in patients with localized oesophageal cancer . This prospect i ve non‐r and omized study evaluated HRQL in patients treated by preoperative chemotherapy and radiation therapy followed by surgery ( multimodal therapy ) or by surgery alone Objective : The aim of this study was to assess long-term health-related quality of life ( HRQL ) in patients after thoracoscopic and open esophagectomy .  Summary of Background Data : Trials comparing minimally invasive with open transthoracic esophagectomy have shown improved short-term outcomes ; however , long-term HRQL data are lacking . This prospect i ve nonr and omized study compared HRQL and survival after  thoracoscopically assisted McKeown esophagectomy ( TAMK ) and open transthoracic Ivor Lewis esophagectomy ( TTIL ) for esophageal or gastroesophageal junction ( GEJ ) cancer . Methods : Patients with esophageal or GEJ cancer selected for TAMK or TTIL  completed baseline and follow-up HRQL assessment s for up to 24 months using the EORTC generic and disease-specific measures , QLQ-C30 and QLQ-OES18 . Baseline clinical variables were examined between the treatment groups and changes in mean HRQL scores over time estimated and tested using generalised estimating equations with propensity score ( generated by boosted regression ) adjust 
    Output:
    
We hypothesized that QoL is consistently better in patients treated with minimally invasive surgery  than in those treated with a more traditional and invasive approach .
Although global health , social function , and emotional function improved more commonly after minimally invasive surgery compared with open surgery , physical function and role function , as well as symptoms including choking , dysphagia , eating problems , and trouble swallowing saliva , declined for both surgery types .
Cognitive function was equivocal across both groups .