Running Head: HRQL After Esophageal Cancer

Title: Meta-analysis shows clinically relevant and long-lasting deterioration in health-related quality of life after esophageal cancer surgery.

Running head: HRQL after esophageal cancer

M. Jacobs1, R.C. Macefield2, R.G. Elbers3, K. Sitnikova1, I.J. Korfage4, E.M.A. Smets1, I.Henselmans1, M.I. van Berge Henegouwen5, J.C.J.M. de Haes1, J.M. Blazeby2,6, M.A.G. Sprangers1

1Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
2 School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom

3 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center/University of Amsterdam,

Amsterdam, The Netherlands

4 Department of Public Health, UniversityMedicalCenterRotterdam, Rotterdam, The Netherlands

5 Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands

6 Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

Corresponding author at:

Marc Jacobs

Dept. Medical Psychology

AcademicMedicalCenter, University of Amsterdam

Meibergdreef 5, 1100DD Amsterdam

PO Box 22660

Netherlands

Tel: +31-20-5668508, fax: +31-20-5669104

E-mail:

Change in 28 HRQL outcomes after open surgery, open surgery combined, and minimally invasive surgery at 3, 6, 9, and 12 months follow-up.
Baseline vs. 3 months / Baseline vs. 6 months / Baseline vs. 9 months / Baseline vs. 12 months
Patientsa / MD/SMD / Heterogeneity / Patientsa / MD/SMD / Heterogeneity / Patientsa / MD/SMD / Heterogeneity / Patientsa / MD/SMD / Heterogeneity
(groups) / (clinical relevance) / Chi2 / Tau2 / I2 / (groups) / (clinical relevance) / Chi2 / Tau2 / I2 / (groups) / (clinical relevance) / Chi2 / Tau2 / I2 / (groups) / (clinical relevance) / Chi2 / Tau2 / I2
(95% UI) / (95% UI) / (95% UI) / (95% UI)
PRIMARY OUTCOMES
Role functioningb positive difference means improved (i.e., improvement in role functioning)
Main
analysis / 1447
(13) / -0.76 [-0.99, -0.53]
medium [large, medium] / P<0.00001 / 0.13 / 77%
(60%-86%) / 1552
(15) / -0.24 [-0.37, -0.11]
small [small, trivial] / P=0.11 / 0.02 / 33%
(0%-64%) / 729
(6) / -0.25 [-0.50, -0.00]
small [medium, trivial] / P=0.03 / 0.06 / 61%
(4%-84%) / 1056
(10) / -0.21 [-0.40, -0.03]
small [small, trivial] / P=0.03 / 0.04 / 51%
(0%-76%)
Open
surgery / 760
(6) / -0.83 [-1.16, -0.51]
large [large, medium] / P=0.0007 / 0.12 / 76%
(47%-90%) / 351
(4) / -0.25 [-0.46, -0.04]
small [ small, trivial] / P=0.10 / 0.03 / 46%
(0%-78%) / 105
(1) / N/A / P=0.13 / 0.03 / 51%
(0%-86%) / 207
(2) / -0.17 [-0.45, 0.10]
small [small, trivial] / P=0.09 / 0.04 / 55%
(0%-85%)
Open
surgery
combined / 401
(4) / -0.92 [-1.32, -0.52]
large [large, medium] / P=0.02 / 0.11 / 69%
(12%-89%) / 380
(4) / -0.38 [-0.68, -0.09]
small [medium, trivial] / P=0.15 / 0.04 / 44%
(0%-81%) / 199
(2) / -0.39 [-0.77, -0.01]
small [medium, trivial] / P=0.18 / 0.03 / 44%
(-) / 358
(4) / -0.16 [-0.39, 0.08]
small [small, trivial] / P=0.33 / 0.01 / 13%
(0%-87%)
Minimally
invasive
surgery / 286
(3) / -0.41 [-0.87, 0.06]
small [large, small] / P=0.03 / 0.12 / 73%
(8%-92%) / 280
(3) / -0.10 [-0.35, 0.14]
trivial [small, trivial] / P=0.36 / 0.36 / 3%
(0%-90%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Eatingc positive difference means improved (i.e., decrease in eating symptoms)
Main
analysis / 1071
(11) / 0.25 [-11.93, 12.42]
trivial [medium, medium] / P<0.00001 / 404.32 / 96%
(94%-97%) / 871
(10) / 5.44 [-4.06, 14.94]
small [trivial, medium] / P<0.00001 / 404.32 / 92%
(88%-95%) / 407
(4) / -4.77 [-20.96, 11.41]
trivial [large, medium] / P<0.00001 / 246.45 / 90%
(78%-96%) / 516
(6) / -4.17 [-15.23, 6.88]
trivial [medium, small] / P<0.00001 / 166.89 / 88%
(76%-94%)
Open
surgery / 370
(4) / -2.17 [-30.41, 26.07]
trivial [large, large] / P<0.00001 / 808.74 / 98%
(96%-99%) / 217
(3) / 3.15 [-28.23, 34.52]
trivial [large,large] / P<0.00001 / 745.92 / 97%
(94%-99%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open
surgery
combined / 405
(4) / 5.34 [-5.15, 15.83]
small [small, medium] / P=0.003 / 90.16 / 79%
(43%-92%) / 269
(3) / 10.47 [0.14, 20.81]
medium [trivial, large] / P=0.04 / 57.57 / 69%
(0%-91%) / 206
(2) / 8.37 [-8.29, 25.03]
small [small, large] / P=0.02 / 118.42 / 82%
(23%-96%) / 240
(3) / 3.47 [-2.19, 9.14]
trivial [small, medium] / P=0.34 / 2.08 / 8%
(0%-90%)
Minimally
invasive
surgery / 296
(3) / -3.52 [-31.29, 24.25]
trivial [large,large] / P<0.00001 / 590.11 / 98%
(97%-99%) / 284
(3) / 3.19 [-13.80, 20.17]
trivial [medium, large] / P<0.00001 / 210.23 / 94%
(86%-97%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Fatigued positive difference means improved (i.e., decrease in fatigue)
Main
analysis / 1057
(11) / -18.22 [-24.97, -11.48]
large [large, medium] / P<0.00001 / 11.85 / 89%
(83%-93%) / 1147
(13) / -9.27 [-12.40, -6.13]
small [medium, small] / P=0.02 / 14,29 / 51%
(7%-74%) / 391
(4) / -12.75 [-17.35, -8.16]
medium [large, small] / P=0.83 / 0,00 / 0%
(0%-48%) / 749
(8) / -7.03 [-11.37, -2.70]
small [medium, small] / P=0.09 / 16.67 / 44%
(0%-75%)
Open
surgery / 370
(4) / -25.24 [-32.00, -18.48]
large [large, large] / P=0.07 / 27.52 / 58%
(0%-86%) / 351
(4) / -11.67 [-17.18, -6.16]
medium [large, small] / P=0.22 / 10,36 / 33%
(0%-76%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -14.34 [-23.15, -5.53]
medium [large, small] / P=0.26 / 7.90 / 0%
(-)
Open
surgery
combined / 401
(4) / -17.84 [-26.73, -8.94]
large [large, small] / P=0.01 / 7.72 / 72%
(20%-90%) / 380
(4 ) / -13.53 [-17.95, -9.12]
medium [large, small] / P=0.37 / 0,93 / 4%
(0%-85%) / 199
(2) / -10.64 [-17.04, -4.25]
medium [large, trivial] / P=0.88 / 0,00 / 0%
(-) / 358
(4) / -3.94 [-7.91, 0.03]
trivial [small, trivial] / P=0.65 / 0,00 / 0%
(0%-72%)
Minimally invasive
surgery / 286
(3) / -10.04 [-18.20, -1.89]
medium [large, trivial] / P=0.0006 / 42.90 / 86%
(61%-95%) / 280
(3) / -4.95 [-7.55, -2.36]
small [small, small] / P=0.43 / 0,00 / 0%
(0%-88%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
SECONDARY OUTCOMES
Physical functioninge positive difference means improved (i.e., improvement in physical functioning)
Main analysis / 1486
(14) / -0.68 [-0.96, -0.40]
medium [large, small] / P<0.00001 / 118.86 / 84%
(75%-90%) / 1546
(16) / -0.37 [-0.58, -0.17]
small [medium, trivial] / P<0.00001 / 55.02 / 73%
(55%-83%) / 729
(6) / -0.43 [-0.64, -0.23]
small [medium, small] / P=0.11 / 0.00 / 44%
(0%-78%) / 1117
(11) / -0.32 [-0.54, -0.11]
small [medium, trivial] / P=0.0002 / 36,92 / 64%
(32%-81%)
Open surgery / 799
(7) / -0.67 [-1.13, -0.21]
medium [large, small] / P<0.00001 / 0.33 / 89%
(79%-94%) / 750
(7) / -0.29 [-0.70, 0.13]
small [medium, small] / P<0.00001 / 0.26 / 86 %
(73%-93%) / 443
(3) / -0.31 [-0.62, -0.01]
small [medium, trivial] / P=0.09 / 0,04 / 58%
(0%-88%) / 576
(5) / -0.28 [-0.71, 0.16]
small [medium, trivial] / P=0.00001 / 0,20 / 83%
(60%-92%)
Open surgery
combined / 401
(4) / -0.80 [-1.21, -0.38]
large [large,small] / P=0.01 / 0.13 / 72%
(22%-90%) / 380
(4) / -0.58 [-0.84, -0.33]
medium [large, small] / P=0.26 / 0.02 / 25%
(0%-89%) / 199
(2) / -0.62 [-0.91, -0.33]
medium [large, small] / P= 0.46 / 0.00 / 0%
(-) / 357
(4) / -0.35 [-0.59, -0.11]
small [medium, trivial] / P=0.31 / 0,01 / 17%
(0%-87%)
Minimally invasive
surgery / 286
(3) / -0.52 [-1.12, 0.09]
medium [large, trivial] / P=0.002 / 0.25 / 84%
(53%-95%) / 280
(3) / -0.25 [-0.49,-0.00]
small [small, trivial] / P=0.26 / 0.00 / 0%
(0%-88%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Social functioninge positive difference means improved (i.e., improvement in social functioning)
Main analysis / 1486
(14) / -0.25 [-0.54, 0.03]
small [medium, trivial] / P<0.00001 / 0.26 / 86%
(78%-91%) / 1546
(16) / 0.09 [-0.08, 0.26]
trivial [trivial, small] / P=0.001 / 0.07 / 60%
(30%-77%) / 729
(6) / -0.15 [-0.34, 0.03]
trivial [small, trivial] / P=0.20 / 0,02 / 31%
(0%-72%) / 1080
(10) / -0.00 [-0.17, 0.16]
trivial [trivial, trivial] / P=0.09 / 0,03 / 40%
(0%-72%)
Open surgery / 799
(7) / -0.23 [-0.72, 0.26]
small [medium, small] / P<0.00001 / 0,39 / 91%
(84%-95%) / 750
(7) / 0.14 [-0.17, 0.44]
trivial[trivial, small] / P=0.0008 / 0.12 / 74%
(44%-88%) / 443
(3) / -0.06 [-0.32, 0.20]
trivial [small, small] / P=0.17 / 0.02 / 43%
(0%-83%) / 538
(4 ) / 0.01 [-0.16, 0.19]
trivial [trivial, trivial] / P=0.43 / 0.00 / 0%
(0%-83%)
Open surgery
combined / 401
(4) / -0.34 [-0.55, -0.14]
small [medium, trivial] / P=0.74 / 0,00 / 0%
(0%-63%) / 380
(4) / 0.03 [-0.26, 0.31]
trivial [small, small] / P=0.17 / 0.03 / 41%
(0%-80%) / 199
(2) / -0.24 [-0.54, 0.06]
small [medium, trivial] / P=0.29 / 0.00 / 11%
(-) / 358
(4) / 0.02 [-0.35, 0.38]
trivial [small, small] / P=0.04 / 0.09 / 63%
(0%-88%)
Minimally invasive
surgery / 286
(3) / -0.19 [-0.97, 0.60]
trivial [large, medium] / P<0.00001 / 0,44 / 90%
(75%-96%) / 280
(3) / 0.08 [-0.42, 0.58]
trivial [small, medium] / P=0.02 / 0.15 / 75%
(18%-93%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Dysphagiad positive difference means improved (i.e., decrease in dysphagia)
Main analysis / 1073
(11) / 6.60 [-2.63, 15.82]
small [trivial, medium] / P<0.00001 / 222.54 / 93%
(89%-95%) / 1121
(12) / 8.68 [0.82, 16.53]
small [trivial, medium] / P<0.00001 / 171.47 / 91%
(86%-94%) / 407
(4) / 3.89 [-8.97, 16.76]
trivial [small, medium] / P<0.001 / 148.08 / 86%
(66%-94%) / 739
(8) / 4.14 [-4.92, 13.19]
trivial [trivial, medium] / P<0.00001 / 140.41 / 84%
(70%-91%)
Open surgery / 370
(4 ) / 6.67 [-16.84, 30.18]
small [medium,large] / P<0.0001 / 553.64 / 96%
(93%-98%) / 351
(4) / 12.64 [-6.03, 31.31]
medium [small, large] / P<0.00001 / 343.62 / 95%
(90%-97%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -1.03 [-15.69, 13.64]
trivial [medium, medium] / P=0.11 / 67.88 / 60%
(0%-91%)
Open surgery
combined / 407
(4) / 8.45 [-3.03, 19.93]
small [trivial,medium] / P=0.0009 / 175.81 / 82%
(53%-93%) / 385
(4) / 6.60 [-9.75, 22.94]
small [small, large] / P<0.00001 / 95.14 / 92%
(82%-96%) / 206
(2) / 14.46 [3.68, 25.24]
medium [trivial, large] / P=0.010 / 38.26 / 63%
(0%-92%) / 351
(4) / 8.97 [-3.64, 21.58]
small [trivial, large] / P<0.00001 / 143.47 / 87%
(69%-95%)
Minimally
invasive
surgery / 296
(3) / 4.29 [-11.26, 19.84]
small [medium,medium] / P<0.0001 / 175.81 / 93%
(84%-97%) / 284
(3) / 6.52 [-5.33, 18.38]
small [small, medium] / P=0.002 / 95.14 / 88%
(67%-96%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Pain (QLQ-OES18)fpositive difference means improved (i.e., decrease in pain)
Main analysis / 1093
(11) / -2.52 [-8.60, 3.55]
trivial [small, trivial] / P<0.00001 / 95.04 / 93%
(89%-95%) / 874
(10) / 3.21 [-0.17, 6.59]
trivial [trivial, small] / P=0.0005 / 17.83 / 70%
(42%-84%) / 407
(4) / 0.04 [-6.77, 6.85]
trivial [small, small] / P=0.01 / 35.13 / 74%
(26%-91%) / 519
(6) / 0.98 [-4.58, 6.54]
trivial [trivial, small] / P=0.006 / 33.10 / 69%
(27%-87%)
Open surgery / 370
(4) / -8.23 [-21.06, 4.60]
small [large, trivial] / P<0.00001 / 159.34 / 93%
(86%-97%) / 217
(3) / -1.89 [-12.44, 8.67]
trivial [medium, small] / P=0.006 / 69.04 / 81%
(39%-94%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open surgery
combined / 427
(4) / -0.65 [-14.49, 13.20]
trivial [medium, medium] / P<0.00001 / 186 / 93%
(86%-97%) / 272
(3) / 6.26 [0.82, 11.71]
medium [trivial,
medium] / P=0.24 / 7.28 / 31%
(0%-93%) / 206
(2) / 3.52 [-8.19, 15.24]
trivial [small, medium] / P=0.03 / 56.86 / 79%
(9%-95%) / 243
(3) / 5.74 [-2.47, 13.94]
small [trivial, medium] / P=0.04 / 36.49 / 70%
(0%-91%)
Minimally
invasive
surgery / 296
(3) / 2.40 [-4.71, 9.50]
trivial [trivial, small] / P<0.00001 / 34.51 / 90%
(74%-96%) / 284
(3) / 4.54 [-0.70, 9.77]
trivial [trivial, small] / P=0.004 / 16.85 / 82%
(45%-94%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Coughing problemsc positive difference means improved (i.e., decrease in coughing problems)
Main analysis / 1072
(11) / -0.43 [-0.69, -0.18]
small [medium, trivial] / P<0.00001 / 0,13 / 75%
(55%-86%) / 773
(9) / -0.43 [-0.58, -0.27]
small [medium, small] / P=0.47 / 0,00 / 0%
(0%-66%) / 406
(4) / -0.40 [-0.61, -0.18]
small [medium, trivial] / P=0.34 / 0,00 / 10%
(0%-86%) / 423
(5) / -0.09 [-0.32, 0.13]
trivial [small, trivial] / P=0.31 / 0,01 / 16%
(0%-83%)
Open surgery / 370
(4) / -0.40 [-0.86, 0.07]
small [large,trivial] / P=0.003 / 0,17 / 78%
(42%-92%) / 217
(3) / -0.45 [-0.84, -0.06]
small [large, trivial] / P=0.15 / 0,06 / 47%
(0%-84%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open surgery
combined / 406
(4) / -0.38 [-0.92, 0.16]
small [large,trivial] / P=0.0002 / 0,25 / 85%
(62%-94%) / 272
(3) / -0.52 [-0.80, -0.23]
medium [large, trivial] / P=0.31 / 0,00 / 5%
(-) / 205
(2) / -0.52 [-0.81, -0.24]
medium [large, small] / P=0.58 / 0,30 / 0%
(-) / 242
(3) / -0.01 [-0.27, 0.26]
trivial [small, small] / P=0.43 / 0,00 / 0%
(0%-88%)
Minimally
invasive
surgery / 296
(3) / -0.54 [-0.93, -0.15]
medium [large,trivial] / P=0.07 / 0,07 / 63%
(0%-89%) / 284
(3) / -0.33 [-0.57, -0.09]
small [medium, trivial] / P=0.70 / 0,00 / 0%
(0%-71%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
OTHER OUTCOMES
Global quality of lifeg positive difference means improved (i.e., improvement in global quality of life)
Main analysis / 1444
(15) / -0.31 [-0.54, -0.08]
small [medium, trivial] / P<0.00001 / 0.14 / 78%
(62%-87%) / 1405
(14) / 0.03 [-0.14, 0.19]
trivial [ trivial, trivial] / P=0.02 / 0.05 / 53%
(5%-72%) / 729
(6) / 0.01 [-0.27, 0.29]
trivial [small, small] / P=0.05 / 0.09 / 70%
(30%-87%) / 985
(9) / 0.04 [-0.12, 0.20]
trivial [trivial, small] / P=0.17 / 0.02 / 31%
(0%-68%)
Open surgery / 757
(6) / -0.30 [-0.55, -0.05]
small [medium, trivial] / P=0.02 / 0.06 / 64%
(13%-85%) / 710
(6) / 0.08 [-0.13, 0.30]
trivial [trivial, small] / P=0.08 / 0.04 / 49%
(0%-80%) / 443
(3) / 0.20 [-0.18, 0.59]
small [trivial, medium] / P=0.02 / 0.09 / 74%
(14%-92%) / 538
(4) / -0.02 [-0.27, 0.24]
trivial [small, small] / P=0.12 / 0.03 / 48%
(0%-83%)
Open surgery
combined / 401
(4) / -0.13 [-0.75, 0.48]
trivial [medium, small] / P<0.0001 / 0.06 / 88%
(73%-95%) / 380
(4) / 0.10 [-0.29, 0.50]
large [small, medium] / P=0.02 / 0.11 / 68%
(8%-89%) / 199
(2) / -0.15 [-0.43, 0.13]
trivial [small, trivial] / P=0.96 / 0.00 / 0%
(-) / 358
(4) / 0.13 [-0.16, 0.42]
trivial [trivial, small] / P=0.16 / 0.04 / 41%
(0%-80%)
Minimally
invasive
surgery / 286
(3) / -0.52 [-1.09, 0.05]
large [large, small] / P=0.004 / 0.21 / 82%
(43%-94%) / 280
(3) / -0.15 [-0.44, 0.14]
trivial [small, trivial] / P=0.24 / 0.02 / 29%
(0%-93%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Emotional functioningdpositive difference means improved (i.e., improvement in emotional functioning)
Main analysis / 1057
(11) / 2.91 [0.22, 5.61]
trivial [trivial,trivial] / P=0.08 / 7.08 / 40%
(0%-70%) / 1147
(13) / 5.58 [2.58, 8.57]
trivial [trivial, small] / P=0.01 / 12.64 / 52%
(0%-59%) / 391
(4) / 4.62 [-0.24, 9.48]
trivial [trivial, medium] / P=0.46 / 0.00 / 0%
(0%-82%) / 764
(8) / 4.93 [0.11, 9.74]
trivial [trivial, medium] / P=0.10 / 19.51 / 42%
(0%-74%)
Open surgery / 370
(4) / 1.71 [-5.99, 9.41]
trivial [small, medium] / P=0.03 / 38.87 / 66%
(0%-88%) / 351
(4) / 4.54 [-2.72, 11.81]
trivial [trivial, medium] / P=0.11 / 27.14 / 51%
(0%-84%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / 4.85 [-8.68, 18.39]
trivial[ small, medium] / P=0.12 / 57.18 / 58%
(0%-90%)
Open surgery
combined / 401
(4) / 7.30 [2.98, 11.63]
small [trivial, medium] / P=0.91 / 0.00 / 0%
(0%-14%) / 380
(4) / 8.78 [1.98, 15.57]
small [trivial, medium] / P=0.07 / 27.14 / 57%
(0%-86%) / 199
(2) / 7.79 [1.19, 14.39]
small [trivial, medium] / P=0.46 / 0.00 / 0%
(-) / 358
(4) / 7.48 [0.46, 14.50]
small [trivial, medium] / P=0.15 / 22.44 / 44%
(0%-81%)
Minimally
invasive
surgery / 286
(3) / 0.81 [-1.52, 3.14]
trivial [trivial, trivial] / P=0.77 / 0.00 / 0%
(0%-60%) / 280
(3) / 2.21 [-0.05, 4.47]
trivial [trivial, trivial] / P=0.70 / 0.00 / 0%
(0%-71%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Cognitive functioningdpositive difference means improved (i.e., improvement in cognitive functioning)
Main analysis / 1053
(11) / -0.56 [-2.65, 1.54]
trivial [small, trivial] / P=0.17 / 3.05 / 28%
(0%-65%) / 1157
(13) / 1.38 [-0.08, 2.84]
trivial [trivial. trivial] / P=0.41 / 0.28 / 4%
(0%-58%) / 391
(5) / -0.47 [-7.94, 7.01]
trivial [medium, medium] / P=0.05 / 36,24 / 62%
(0%-87%) / 749
(8) / 0.19 [-3.77, 4.15]
trivial [small, small] / P=0.10 / 13,52 / 42%
(0%-75%)
Open surgery / 366
(4) / -2.33 [-7.74, 3.09]
small [medium,small] / P=0.07 / 17.10 / 58%
(0%-86%) / 351
(4) / 0.89 [-3.95, 5.73]
trivial [small, small] / P=0.13 / 11.25 / 47%
(0%-82%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -4.26 [-15.03, 6.51]
small [medium,small] / P=0.10 / 38.53 / 64%
(0%-92%)
Open surgery
combined / 401
(4) / -2.48 [-7.22, 2.25]
small [medium, trivial] / P=0.55 / 0.00 / 0%
(0%-78%) / 380
(4) / -0.01 [-4.94, 4.92]
trivial [small, small] / P=0.18 / 9.74 / 39%
(0%-79%) / 199
(2) / 4.72 [-6.05, 15.49]
small [small, medium] / P=0.10 / 37.73 / 62%
(0%-91%) / 358
(4) / 2.30 [-3.05, 7.65]
trivial [small, small] / P=0.15 / 12.87 / 43%
(0%-81%)
Minimally
invasive
surgery / 286
(3) / 0.58 [-1.97, 3.14]
trivial [small, small] / P=0.22 / 1.73 / 33%
(0%-78%) / 280
(3) / 1.43 [-0.30, 3.16]
trivial [trivial, small] / P=0.68 / 0.00 / 0%
(0%-73%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Nausea & Vomitingdpositive difference means improved (i.e., decrease in nausea & vomiting)
Main analysis / 1056
(11) / -6.85 [-10.85, -2.86]
small [small, trivial] / P<0.00001 / 31.90 / 78%
(61%-88%) / 1146
(13) / -1.85 [-4.59, 0.89]
trivial [trivial,trivial] / P=0.007 / 12.09 / 56%
18%-76% / 391
(4) / -5.98 [-9.51, -2.46]
small [small, trivial] / P=0.53 / 0.00 / 0%
(0%-79%) / 747
(8) / -3.36 [-8.03, 1.31]
trivial [small, trivial] / P=0.003 / 29.61 / 68%
(32%-85%)
Open surgery / 370
(4) / -8.24 [-17.19, 0.72]
small [large,trivial] / P=0.0003 / 66.97 / 84%
(60%-94%) / 351
(4) / -1.23 [-8.22, 5.77]
trivial [small, small] / P=0.01 / 34.37 / 73%
(22%-90%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -5.66 [-17.40, 6.08]
small [large,small] / P=0.01 / 60.35 / 84%
(33%-96%)
Open surgery
combined / 400
(4) / -7.39 [-12.21, -2.57]
small [medium, trivial] / P=0.23 / 7.22 / 30%
(0%-75%) / 379
(4) / -3.21 [-6.97, 0.55]
trivial [small, trivial] / P=0.47 / 0.00 / 0%
(0%-82%) / 199
(2) / -3.80 [-8.86, 1.26]
trivial [small, trivial] / P=0.57 / 0.00 / 0%
(-) / 356
(4) / -1.57 [-7.98, 4.85]
trivial [small, small] / P=0.06 / 25.08 / 60%
(0%-87%)
Minimally
invasive
surgery / 286
(3) / -5.30 [-12.59, 1.99]
small [medium,trivial] / P=0.0005 / 32.80 / 87%
(62%-95%) / 280
(3) / -3.23 [-8.91, 2.44]
trivial [small, trivial] / P=0.04 / 19.51 / 82%
(42%-94%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Pain (QLQ-C30)dpositive difference means improved (i.e., decrease in pain)
Main analysis / 1057
(11) / -10.46 [-14.93, -5.99]
small [medium, small] / P=0.0001 / 37.73 / 72%
(47%-85%) / 1147
(13) / -5.18 [-8.25, -2.11]
small [small, trivial] / P=0.03 / 13.01 / 46%
(0%-72%) / 391
(4) / -6.74 [-11.45, -2.03]
small [medium,trivial] / P=0.44 / 0.00 / 0%
(-) / 749
(8) / -4.88 [-8.30, -1.45]
small [small, trivial] / P=0.75 / 0.00 / 0%
(-)
Open surgery / 370
(4) / -17.12 [-24.32, -9.92]
medium [large, small] / P0.05 / 33 / 61%
(0%-87%) / 351
(4) / -11.07 [-15.31, -6.83]
medium [medium, small] / P=0.88 / 0.00 / 0%
(0%-32%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -9.45 [-16.66, -2.25]
small [medium, small] / P=0.060 / 0.00 / 0%
(-)
Open surgery
combined / 401
(4) / -6.90 [-11.60, -2.21]
small [medium, trivial] / P=0.62 / 0.00 / 0%
(0%-74%) / 380
(4) / 0.55 [-5.81, 6.91]
trivial [small, small] / P=0.13 / 19.55 / 47%
(0%-82%) / 199
(2) / -5.09 [-11.45, 1.28]
small [medium, trivial] / P=0.66 / 0.00 / 0%
(-) / 358
(4) / -2.77 [-7.58, 2.04]
trivial [small, trivial] / P=0.63 / 0.00 / 0%
(0%-73%)
Minimally
invasive
surgery / 286
(3) / -6.13 [-12.01, -0.24]
small [medium,trivial] / P=0.05 / 16.86 / 67%
(0%-90%) / 280
(3) / -3.45 [-6.30, -0.61]
small [small, trivial] / P=0.61 / 0.00 / 0%
(0%-79%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Dyspnoeadpositive difference means improved (i.e., decrease in dyspnoea)
Main analysis / 1057
(11) / -15.89 [-20.16, -11.62]
medium [medium,medium] / P=0.02 / 27.95 / 54%
(32%-81%) / 1046
(12) / -11.80 [-15.48, -8.11]
medium [medium, small] / P=0.11 / 14.17 / 35%
(0%-60%) / 391
(4) / -11.78 [-20.05, -3.51]
medium [medium, trivial] / P=0.04 / 45.80 / 65%
(0%-88%) / 649
(7) / -7.10 [-10.51, -3.70]
small [small, trivial] / P=0.55 / 0.00 / 0%
(0%-65%)
Open surgery / 370
(4) / -16.49 [-21.30, -11.68]
medium [medium, medium] / P=0.54 / 0.00 / 0%
(0%-84%) / 351
(4) / -10.42 [-15.40, -5.43]
small [medium, medium] / P=0.40 / 0.00 / 0%
(-) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -5.64 [-12.13, 0.84]
small [medium, trivial] / P=0.27 / 4.74 / 19%
(-)
Open surgery
combined / 401
(4) / -17.75 [-27.22, -8.28]
medium [medium,medium] / P=0.009 / 68.85 / 74%
(28%-91%) / 380
(4) / -15.90 [-22.33, -9.46]
medium [medium, small] / P=0.16 / 17.83 / 42%
(0%-81%) / 199
(2) / -17.98 [-26.74, -9.22]
Medium [medium, small] / P=0.09 / 17.14 / 42%
(-) / 352
(4) / -8.81 [-13.44, -4.17]
small [medium, trivial] / P=0.53 / 0.00 / 0%
(0%-79%)
Minimally
invasive
surgery / 286
(3) / -11.66 [-19.17, -4.14]
medium [medium, small] / P=0.13 / 22.75 / 52%
(0%-86%) / 280
(3) / -8.08 [-14.62, -1.54] [small [medium, trivial] / P=0.23 / 10.61 / 32%
(0%-93%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Appetite lossdpositive difference means improved (i.e., decrease in appetite loss)
Main analysis / 1057
(11) / -10.37 [-19.45, -1.29]
small [medium,trivial] / P<0.00001 / 203.71 / 88%
(81%-93%) / 1147
(13) / -1.56 [-6.72, 3.60]
trivial [small,trivial] / P=0.0004 / 55.54 / 66%
(39%-81%) / 391
(4) / -6.02 [-12.10, 0.06]
small [small, trivial] / P=0.27 / 8.82 / 23%
(0%-88%) / 747
(12) / -3.56 [-9.71, 2.59]
trivial[small,trivial] / P=0.04 / 39.16 / 52%
(0%-78%)
Open surgery / 370
(4) / -14.90 [-28.84, -0.95]
medium [large, trivial] / P=0.0006 / 167 / 83%
(56%-93%) / 351
(4) / -7.90 [-19.86, 4.06]
small [medium, trivial] / P=0.01 / 106.07 / 72%
(19%-90%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -11.45 [-23.18, 0.27]
small [medium, trivial] / P=0.22 / 23.89 / 33%
(-)
Open surgery
combined / 401
(4) / 6.75 [-24.89, 11.40]
trivial [medium, small] / P<0.00001 / 304.37 / 89%
(76%-95%) / 380
(4) / 2.03 [-10.73, 14.78]
trivial [small, medium] / P=0.002 / 132.54 / 79%
(44%-92%) / 199
(2) / -1.55 [-14.12, 11.03] [trivial [medium, small] / P=0.12 / 50.43 / 60%
(0%-91%) / 356
(4) / -0.27 [-5.83, 5.29]
trivial [small, medium] / P=0.43 / 0.00 / 0%
(0%-83%)
Minimally
invasive
surgery / 286
(3) / -9.40 [-27.34, 8.54]
small [large,small] / P<0.00001 / 228.43 / 93%
(83%-97%) / 280
(3) / -0.63 [-7.10, 5.84]
trivial [small,trivial] / P=0.10 / 18.44 / 57%
(0%-88%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Constipationdpositive difference means improved (i.e., decrease in constipation)
Main analysis / 1056
(11) / 0.43 [-3.37, 4.23]
trivial [trivial, small] / P=0.03 / 20.07 / 51%
(1%-75%) / 1045
(12) / 3.40 [-0.80, 7.60]
trivial [trivial,small] / P=0.002 / 31.61 / 62%
(29%-80%) / 391
(4) / 1.37 [-2.39, 5.14]
trivial [trivial,small] / P=0.38 / 0.40 / 3%
(0%-85%) / 654
(7) / 3.90 [-2.33, 10.14]
trivial [trivial,medium] / P=0.002 / 48.58 / 71%
(36%-87%)
Open surgery / 370
(4) / 0.38 [-7.15, 7.92]
trivial [small, small] / P=0.05 / 36.17 / 61%
(0%-87%) / 351
(4) / -0.93 [-6.44, 4.57]
trivial [small, small] / P=0.31 / 5.24 / 16%
(0%-87%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -1.05 [-12.81, 10.71]
trivial [small, medium] / P=0.14 / 39.04 / 54%
(0%-89%)
Open surgery
combined / 400
(4) / 3.68 [-3.77, 11.13]
trivial [trivial,medium] / P=0.07 / 33.05 / 58%
(0%-86%) / 379
(4) / 9.73 [0.45, 19.02]
small [trivial, medium] / P=0.006 / 63.10 / 76%
(33%-91%) / 199
(2) / 3.21 [-3.17, 9.59]
trivial [trivial, small] / P=0.24 / 7.08 / 29%
(-) / 358
(4) / 6.48 [-2.56, 15.52]
small [trivial, medium] / P=0.001 / 82.53 / 81%
(50%-93%)
Minimally
invasive
surgery / 286
(3) / -2.51 [-8.77, 3.74]
trivial [small, trivial] / P=0.14 / 14.73 / 49%
(0%-85%) / 280
(3) / -0.48 [-4.41, 3.45]
trivial [trivial, trivial] / P0=0.91 / 0.00 / 0%
(-) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Diarrheadpositive difference means improved (i.e., decrease in diarrhea)
Main analysis / 1057
(11) / -13.30 [-18.52, -8.08]
small [medium,small] / P<0.00001 / 58.51 / 78%
(61%-88%) / 1044
(12) / -10.78 [-15.48, -6.08]
small [medium,small] / P<0.0001 / 47.21 / 73%
(52%-85%) / 391
(4) / -14.57 [-20.51, -8.64]
small [medium,small] / P=0.10 / 18.45 / 51%
(0%-84%) / 654
(7) / -12.66 [-17.27, -8.05]
small [medium,small] / P=0.06 / 18,60 / 50%
(0%-79%)
Open surgery / 370
(4) / -14.01 [-19.44, -8.58]
small [medium, small] / P=0.21 / 10.38 / 34%
(0%-77%) / 351
(4) / -10.92 [-16.15, -5.69]
small [large, small] / P=0.25 / 7.88 / 28%
(0%-73%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -8.30 [-13.09, -3.52]
small [small, trivial] / P=0.70 / 0.00 / 0%
(-)
Open surgery
combined / 401
(4) / -17.42 [-21.23, -13.62]
medium [medium, small] / P=0.41 / 0.00 / 0%
(0%-84%) / 378
(4) / -13.42 [-18.85, -8.00]
small [medium, small] / P=0.10 / 15.78 / 52%
(0%-84%) / 199
(2) / -13.21 [-23.97, -2.44]
small [medium, trivial] / P=0.04 / 46.56 / 77%
(0%-95%) / 358
(4) / -12.40 [-17.12, -7.67]
small [medium, small] / P=0.33 / 3.03 / 13%
(0%-87%)
Minimally
invasive
surgery / 286
(3) / -7.38 [-19.19, 4.43]
small [medium,small] / P=0.001 / 90.41 / 85%
(57%-95%) / 280
(3) / -6.19 [-17.79, 5.40]
small [medium, small] / P= 0.002 / 85.37 / 84%
(52%-95%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Insomniadpositive difference means improved (i.e., decrease in insomnia)
Main analysis / 1057
(11) / -1.77 [-4.72, 1.18]
trivial [small,small] / P=0.60 / 0.00 / 0%
(0%-52%) / 1046
(12) / 0.86 [-2.15, 3.87]
trivial [small,trivial] / P=0.42 / 0.78 / 3%
(0%-60%) / 391
(4) / 4.18 [-1.54, 9.89]
trivial [trivial,medium] / P=0.76 / 0.00 / 0%
(-) / 652
(7) / 2.43 [-2.78, 7.64]
trivial [small, small] / P=0.32 / 7.34 / 15%
(0%-59%)
Open surgery / 370
(4) / -3.41 [-9.05, 2.23]
small [medium, trivial] / P=0.26 / 2.53 / 8%
(0%-86%) / 351
(4) / -0.35 [-8.41, 7.71]
trivial [small, small] / P=0.10 / 34.24 / 51%
(0%-84%) / 105 (1) / N/A / N/A / N/A / N/A / 207
(2) / -6.51 [-15.61, 2.59]
small [medium, trivial] / P=0.91 / 0.00 / 0%
(-)
Open surgery
combined / 401
(4) / 0.20 [-5.74, 6.13]
trivial [small, small] / P=0.40 / 0.00 / 0%
(0%-85%) / 380
(4) / 4.37 [-1.89, 10.62]
trivial [trivial, medium] / P=0.36 / 2.97 / 7%
(0%-86%) / 199 (2) / 7.00 [-0.66, 14.66]
small[trivial,medium] / P=1.00 / 0.00 / 0%
(-) / 356
(4) / 7.33 [1.22, 13.45]
small [trivial, medium] / P=0.89 / 0.00 / 0%
(0%-29%)
Minimally
invasive
surgery / 286
(3) / -1.79 [-6.17, 2.58]
trivial [small, trivial] / P=0.52 / 0.00 / 0%
(0%-85%) / 280
(3) / -0.60 [-4.95, 3.75]
trivial [small, trivial] / P=0.96 / 0.00 / 0%
(-) / 87 (1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Financial difficultiesdpositive difference means improved (i.e., decrease in financial difficulties)
Main analysis / 1056
(11) / -4.95 [-7.75, -2.14]
small [small,small] / P=0.42 / 0.42 / 2%
(0%-61%) / 1045
(12) / -0.96 [-3.36, 1.44]
trivial [small,trivial] / P=0.64 / 0.00 / 0%
(0%-48%) / 390
(4) / -6.23 [-10.48, -1.97]
small [medium, trivial] / P=0.54 / 0.00 / 0%
(0%-79%) / 654
(7) / -2.98 [-12.65, 6.68]
small [medium, small] / P<0.00001) / 136.57 / 83%
(68%-92%)
Open surgery / 370
(4) / -7.63 [-13.01, -2.25]
small [medium, small] / P=0.61 / 0.00 / 0%
(0%-75%) / 351
(4) / -5.13 [-11.50, 1.24]
small [medium, trivial] / P=0.80 / 0.00 / 0%
(0%-55%) / 105
(1) / N/A / N/A / N/A / N/A / 207
(2) / -9.69 [-18.22, -1.16]
small [medium, trivial] / P=0.59 / 0.00 / 0%
(-)
Open surgery
combined / 400
(4) / -4.69 [-9.76, 0.38]
small [small, trivial] / P=0.72 / 0.00 / 0%
(0%-66%) / 379
(4) / 0.03 [-3.45, 3.52]
trivial [small, small] / P=0.38 / 0.52 / 2%
(0%-85%) / 198
(2) / -4.81 [-10.21, 0.60]
small [medium, trivial] / P=0.39 / 0.00 / 0%
(-) / 358
(4) / -0.74 [-13.68, 12.20]
trivial [medium, medium] / P<0.00001 / 260.67 / 91%
(79%-96%)
Minimally
invasive
surgery / 286
(3) / -4.94 [-12.32, 2.44]
small [medium, trivial] / P=0.06 / 26.63 / 64%
(0%-90%) / 280
(3) / -1.06 [-6.05, 3.92]
trivial [small, small] / P=0.27 / 4.68 / 23%
(0%-92%) / 87
(1) / N/A / N/A / N/A / N/A / 89
(1) / N/A / N/A / N/A / N/A
Refluxcpositive difference means improved (i.e., decrease in reflux)
Main analysis / 1076
(11) / -0.60 [-0.94, -0.26]
medium [large, small] / P<0.00001 / 0.27 / 86%
(76%-91%) / 874
(10) / -0.55 [-1.00, -0.11]
medium [large, trivial] / P<0.00001 / 0.45 / 89%
(82%-93%) / 407
(4) / -0.43 [-0.70, -0.16]
small [medium, trivial] / P=0.16 / 0.03 / 42%
(0%-80%) / 518
(6) / -0.44 [-0.63, -0.26]
small [medium, small] / P=0.84 / 0.00 / 0%
(0%-40%)
Open surgery / 373
(4) / -0.74 [-1.44, -0.05]
medium [large,trivial] / P<0.00001 / 0.44 / 90%
(76%-95%) / 217
(3) / -0.94 [-1.36, -0.52]
large [large, medium] / P=0.14 / 0.07 / 49%
(0%-85%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A
Open surgery
combined / 407
(4) / -0.12 [-0.33, 0.08]
trivial [small, trivial] / P=0.58 / 0.00 / 0%
(0%-77%) / 272
(3) / -0.13 [-0.41, 0.15]
trivial [small, trivial] / P=0.31 / 0.01 / 15%
(0%-91%) / 206
(2) / -0.33 [-0.69, 0.04]
small [medium, trivial] / P=0.19 / 0.03 / 41%
(-) / 242
(3) / -0.53 [-0.79, -0.26]
medium [medium, small] / P=0.98 / 0.00 / 0%
(-)
Minimally
invasive
surgery / 296
(3) / -1.07 [-1.50, -0.64]
large [large, medium] / P=0.05 / 0.10 / 67%
(0%-90%) / 284
(3) / -0.94 [-1.70, -0.17]
large [large, trivial]] / P=0.0001 / 0.40 / 89%
(69%-96%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Trouble swallowing salivafpositive difference means improved (i.e., decrease in trouble swallowing saliva)
Main analysis / 541
(6) / 1.28 [-2.39, 4.94]
trivial [trivial, trivial] / P=0.08 / 27.65 / 49%
(0%-80%) / 523
(7) / 3.90 [1.10, 6.70]
trivial [trivial, small] / P=0.22 / 2.94 / 30%
(0%-72%) / 205
(2) / 0.80 [-8.99, 10.59]
trivial [small, medium] / P=0.15 / 25.58 / 51%
(0%-88%) / 237
(3) / -1.02 [-5.05, 3.01]
trivial [small, trivial] / P=0.38 / 0.00 / 0%
(0%-89%)
Open surgery / 58
(1) / 0.00 [-8.75, 8.75]
trivial [small, small] / N/A / N/A / N/A / 58
(1) / 2.00 [-6.75, 10.75]
trivial [small, medium] / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery
combined / 289
(3) / 2.43 [-2.78, 7.63]
trivial [small, small] / P=0.33 / 2.25 / 10%
(0%-91%) / 271
(3) / 2.01 [-8.72, 12.75]
trivial [small,medium] / P=0.07 / 41.74 / 69%
(0%-93%) / 205
(2) / 0.80 [-8.99, 10.59]
trivial [small, medium] / P=0.15 / 25.58 / 51%
(0%-88%) / 237
(3) / -1.02 [-5.05, 3.01]
trivial [small, trivial] / P=0.38 / 0.00 / 0%
(-)
Minimally
invasive
surgery / 194
(2) / 0.21 [-7.62, 8.04]
trivial [small, small] / P=0.007 / 27.65 / 86%
(46%-97%) / 194
(2) / 4.83 [2.52, 7.13]
trivial [trivial, small] / P=0.40 / 0.00 / 0
(-) / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Choking when swallowingfpositive difference means improved (i.e., decrease in choking when swallowing)
Main analysis / 525
(6) / 5.84 [-3.39, 15.07]
small [trivial, medium] / P<0.00001 / 0.00 / 89%
(76%-95%) / 527
(6) / 5.99 [-2.36, 14.33]
small [trivial, medium] / P<0.00001 / 91.88 / 87%
(73%-93%) / 205
(2) / -0.36 [-7.01, 6.28]
Trivial [small, small] / P=0.15 / 12.69 / 52%
(0%-88%) / 242
(3) / -3.79 [-13.63, 6.05]
trivial [medium, small] / P=0.006 / 60.47 / 81%
(39%-94%)
Open surgery / 58
(1) / 8.00 [-2.50, 18.50]
small [trivial, medium] / N/A / N/A / N/A / 58
(1) / 7.00 [-3.50, 17.50]
small [trivial, medium] / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery
combined / 273
(3) / -1.24 [-16.91, 14.44]
[trivial [medium,medium] / P=0.0008 / 116.64 / 91%
(68%-98%) / 275
(3) / 1.07 [-10.80, 12.93]
trivial [medium,medium] / P=0.001 / 92.44 / 85%
(56%-95%) / 205
(2) / -0.36 [-7.01, 6.28]
trivial [small, small] / P= 0.15 / 12.69 / 52%
(0%-88%) / 242
(3) / -3.79 [-13.63, 6.05]
trivial [medium, small] / P=0.006 / 60.47 / 81%
(39%-94%)
Minimally
invasive
surgery / 194
(2) / 12.00 [7.49, 16.51]
medium [small, medium] / P=1.00 / 0.00 / 0%
(-) / 194
(2) / 12.48 [7.90, 17.06]
medium [small, medium] / P=0.83 / 0.00 / 0
(-) / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Dry mouthf positive difference means improved (i.e., decrease in dry mouth)
Main analysis / 1072
(11) / -0.52 [-4.79, 3.75]
trivial [trivial,trivial] / P=0.003 / 29.73 / 63%
(29%-81%) / 874
(10) / 0.38 [-2.91, 3.66]
trivial [trivial, trivial] / P=0.16 / 7.99 / 32%
(0%-67%) / 407
(4) / -6.64 [-12.20, -1.08]
Small [medium, trivial] / P=0.31 / 5.15 / 16%
(0%-87%) / 422
(5) / -4.56 [-12.08, 2.96]
trivial [medium, trivial] / P.10 / 34.18 / 48%
(0%-81%)
Open surgery / 370
(4) / -1.79 [-8.46, 4.88]
trivial [small, trivial] / P=0.13 / 22.04 / 48%
(0%-83%) / 217
(3) / -1.22 [-6.89, 4.45]
trivial [small, trivial] / P=0.72 / 0.00 / 0%
(0%-69%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open surgery
combined / 406
(4) / 2.24 [-9.94, 14.42]
trivial [small,medium] / P=0.004 / 119.19 / 78%
(39%-92%) / 272
(3) / 0.90 [-8.96, 10.76]
trivial [small,medium] / p=0.07 / 47.34 / 63%
(0%-89%) / 206
(2) / -6.79 [-13.87, 0.28]
small [medium, trivial] / P=0.79 / 0.00 / 0%
(-) / 241
(3) / 0.46 [-5.28, 6.21]
trivial [small, small] / P=0.93 / 0.00 / 0%
(-)
Minimally
invasive
surgery / 296
(3) / -0.67 [-7.09, 5.75]
trivial [small,small] / P=0.03 / 22.01 / 72%
(5%-92%) / 284
(3) / -0.08 [-6.21, 6.05]
trivial [small,small] / P=0.06 / 17.72 / 66%
(0%-90%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Speech problemsfpositive difference means improved (i.e., decrease in speech problems)
Main analysis / 753
(8) / -4.19 [-6.96, -1.41]
trivial [small,trivial] / P=0.16 / 4.96 / 33%
(0%-70%) / 713
(8) / -1.12 [-2.92, 0.68]
trivial [trivial, trivial] / P=0.86 / 0.00 / 0%
(0%-31%) / 406
(9) / -3.75 [-6.55, -0.95]
trivial [small, trivial] / P=0.39 / 0.12 / 1%
(0%-85%) / 423
(5) / -3.86 [-7.07, -0.66]
trivial [small, trivial] / P=0.77 / 0.00 / 0%
(0%-54%)
Open surgery / 169
(2) / -5.87 [-11.90, 0.15]
small [medium, trivial] / P=0.64 / 0.00 / 0%
(-) / 157
(2) / -4.17 [-9.65, 1.32]
trivial [small, trivial] / P=0.72 / 0.00 / 0%
(-) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open surgery
combined / 288
(3) / -4.16 [-8.43, 0.11]
trivial [small, trivial] / P=0.35 / 0.68 / 4%
(0%-90%) / 272
(3) / 0.20 [-2.44, 2.85]
trivial [trivial, trivial] / P=0.90 / 0.00 / 0%
(-) / 205
(2) / -3.06 [-6.38, 0.27]
trivial [small, trivial] / P=0.30 / 0.62 / 8%
(-) / 242
(3) / -3.00 [-6.44, 0.44]
trivial [small, trivial] / P=1.00 / 0.00 / 0%
(-)
Minimally
invasive
surgery / 296
(3) / -4.84 [-10.56, 0.89]
trivial [medium,trivial] / P=0.03 / 17.41 / 73%
(8%-92%) / 284
(3) / -1.77 [-4.50, 0.96]
trivial [trivial, trivial] / P=0.75 / 0.00 / 0%
(0%-65%) / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
Taste problemsc positive difference means improved (i.e., decrease in taste problems)
Main analysis / 1070
(11) / -0.20 [-0.43, 0.03]
small [small,trivial] / P=0.0002 / 0.11 / 71%
(46%-84%) / 872
(10) / -0.01 [-0.21, 0.19]
trivial [small, trivial] / P=0.02 / 0.13 / 50%
(0%-76%) / 405
(4) / -0.22 [-0.49, 0.06]
small [small, trivial] / P=0.15 / 0.03 / 43%
(0%-81%) / 517
(6) / -0.08 [-0.34, 0.17]
trivial [small, trivial] / P=0.09 / 0.05 / 47%
(0%-79%)
Open surgery / 370
(4) / -0.19 [-0.69, 0.31]
trivial [medium, small] / P=0.001 / 0.21 / 82%
(52%-93%) / 217
(3) / -0.05 [-0.60, 0.50]
trivial [medium, medium] / P=0.02 / 0.17 / 73%
(10%-92%) / 105
(1) / N/A / N/A / N/A / N/A / 95
(1) / N/A / N/A / N/A / N/A
Open surgery
combined / 404
(4) / -0.27 [-0.47, -0.06]
small [small, trivial] / P=0.80 / 0.00 / 0%
(0%-55%) / 270
(3) / -0.07 [-0.32, 0.18]
trivial [small, trivial] / P=0.85 / 0.00 / 0%
(0%-37%) / 204
(2) / 0.01 [-0.27, 0.29]
trivial [small, small] / P=0.73 / 0.00 / 0%
(-) / 241
(3) / 0.03 [-0.23, 0.29]
trivial [small, small] / P=0.53 / 0.00 / 0%
(0%-83%)
Minimally
invasive
surgery / 296
(3) / -0.15 [-0.81, 0.51]
trivial [large, small] / P=0.0004 / 0.29 / 87%
(64%-96%) / 284
(3) / -0.02 [-0.50, 0.46]
trivial [medium,small] / P=0.02 / 0.13 / 75%
(16%-92%) / 96
(1) / N/A / 86
(1) / N/A / N/A / N/A / N/A
Trouble talkingd positive difference means improved (i.e., decrease in trouble talking)
Main analysis / 318
(3) / 6.64 [-8.97, 22.26]
small [small,large] / P<0.0001 / 170.35 / 90%
(72%-96%) / 60
(1) / N/A / N/A / N/A / N/A / 0
(0 ) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery / 201
(2) / 11.34 [-11.19, 33.88]
medium [medium, large] / P=0.0001 / 246.77 / 93%
(78%-98%) / 60
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery
combined / 117
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Minimally
invasive
surgery / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Deglutitionc positive difference means improved (i.e., decrease in deglutition)
Main analysis / 561
(3) / -0.45 [-0.97, 0.06]
small [large,trivial] / P<0.00001 / 0.30 / 88%
(76%-95%) / 249
(3) / -0.48 [-1.38, 0.42]
small [large, small] / P<0.0001 / 20.68 / 90%
(74%-96%) / 201
(2) / -0.58 [-0.88, -0.28]
medium [large, small] / P=0.69 / 0.00 / 0%
(-) / 86
(1) / N/A / N/A / N/A / N/A
Open surgery / 312
(2) / -0.43 [-1.08, 0.21]
small [large, small] / P=0.006 / 0.28 / 86%
(-) / 159
(2) / -0.19 [-1.48, 1.10]
trivial [large, large] / P=0.0002 / 0.80 / 93%
(76%-98%) / 105
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery
combined / 147
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Minimally
invasive
surgery / 120
(1) / N/A / N/A / N/A / N/A / 90
(1) / N/A / N/A / N/A / N/A / 96
(1) / N/A / N/A / N/A / N/A / 86
(1) / N/A / N/A / N/A / N/A
FACT-Ehpositive difference means improved (i.e., decrease in FACT-E)
Main analysis / 121
(3) / 1.39 [-7.69, 10.47] / P=0.58 / 0.00 / 0%
(0%-81%) / 39
(2) / 4.22 [-15.32, 23.76] / P=0.23 / 58.29 / 29%
(-) / 36
(2) / 2.98 [-14.52, 20.48] / P=0.70 / 0.00 / 0%
(-) / 0
(0) / N/A / N/A / N/A / N/A
Open surgery / 21
(1) / N/A / N/A / N/A / N/A / 16
(1) / N/A / N/A / N/A / N/A / 16
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Open surgery
combined / 100
(2) / -0.69 [-10.62, 9.24] / P=0.80 / 0.00 / 0%
(-) / 23
(1) / N/A / N/A / N/A / N/A / 20
(1) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A
Minimally invasive
surgery / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A / 0
(0) / N/A / N/A / N/A / N/A

N/A not applicable(this means that no two patient groups were available to derive a summary estimate of HRQL change by meta-analysis)

MD Mean difference / mean change, SMD standardized mean difference / standardized mean change

a The amount of patients in each analysis are the number of patients at baseline and the given follow-up time (e.g., the number of patients at 3 months follow-up represent the number of patients at baseline and the number of patients at 3 months follow-up, combined).

b Standardized mean difference; measured by the QLQ-C30 and the MOS-SF-20

c Mean difference; measured by the QLQ-OES18 and the QLQ-OES24

d Mean difference; measured by the QLQ-C30

e Standardized mean difference; measured by the QLQ-C30, the MOS-SF-20, and the SF-36.

f Mean difference; measured by the QLQ-OES18

g Standardized mean difference; measured by the QLQ-C30, and the a-RSCL

hMean difference; measured by the FACT-E

'Sufficiently' homogenous estimatesare presented in bold (I2 ≤50% AND P≥ 0.1)