Long-term outcomes after esophagectomy for end-stage achalasia: A bridge to a better quality of life?

Objective: We sought to evaluate the outcomes of patients with end-stage achalasia (ESA) who underwent esophagectomy. Methods: All patients who underwent esophagectomy for ESA and replied to a QoL-centred questionnaire from 2002 to 2015 were included. Results: Overall, 14 patients underwent esophagectomy for ESA, 12 (85.7%) patients completed the questionnaire and were included in the study. Patients were referred for esophagectomy after 18.5 median years (IQR1-3 13.5–35.25) since presentation of symptoms. Heller's myotomy was previously performed in eight patients (66.7%). Major postoperative complications occurred in 2 (16.7%) patients. No patients required reoperation, and there was no postoperative mortality. At a median follow-up of 84 months (IQR1-3 60–84 months), satisfaction in postoperative symptom control was reported in 10 (83.3%) patients. Patients reported significant improvements in frequency of dysphagia (p <.001), regurgitation (p =.004), heartburn (p =.034), cough (p =.003), and odynophagia (p =.001). Specifically, incidence of dysphagia for liquid food was reduced from 100% to 16.7% (p <.001), for semisolid food from 81.8% to 16.7% (p =.003), and for solid food from 100% to 41.7% (p =.005). Conclusions: In select patients suffering from long-standing ESA, esophagectomy is feasible and is associated with good perioperative and long-term outcomes.