Safety and outcomes after oesophagectomy in southern New Zealand: a 25‐year audit of a low volume centre. Issue 7 (12th February 2021)

• Record Type: Journal Article
• Authors: Elliott, Thomas B.; Cha, Ryan; Clifford, Kari; Popadich, Aleksandra; Nagra, Sonal
• Is Part Of: ANZ journal of surgery. Volume 91:Issue 7/8(2021)
• Page Start: 1509
• Page End: 1514
• Publication Date: 2021-02-12
• Subjects: audit -- oesophageal cancer -- oesophagectomy -- upper gut; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.16644
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Over the last 2 decades, outcomes for oesophageal cancer have improved due to advances in surgical and oncological practice. Optimizing outcomes by centralization of oesophagectomy to high‐volume centres has been observed. The aim of this study was to establish if technical and oncological outcomes after oesophagectomy in southern New Zealand are comparable to recent benchmarks. Methods: Consecutive patients undergoing oesophagectomy for cancer and benign pathology at Dunedin Hospital from 1995 to 2019 were prospectively audited. For malignant cases, histology was obtained retrospectively along with details of neo‐adjuvant and adjuvant therapy. The primary outcome was disease‐specific survival, stratified by time, resection margin, and TNM staging. Secondary outcomes included mortality and morbidity of oesophagectomy. Complications were graded using the Clavien‐Dindo classification. Results: Oesophagectomy was performed in 108 patients, and 99 patients had surgery for oesophageal malignancy. The median survival was 35.3 (95% confidence interval (CI) 30.0–93.4) months and the 5‐year survival overall was 41.7%. Comparing survival in patients undergoing oesophagectomy up to 2006 and afterwards showed an improvement in 5‐year survival (30.3%, 95% CI (14.2–60.0) versus 47.8%, 95% CI (32.5, not reached), respectively, P = 0.041). There were two perioperative deaths (1.8%), six clinical anastomotic leaks (5.5%), four anastomotic strictures (3.7%) and five chylothoraces (4.6%). Conclusion: This 25‐year survey of oesophagectomy in southern New Zealand audits the results of a low volume centre, where a variety of neo‐adjuvant treatments have been used. Despite this, perioperative morbidity, mortality and survival are comparable to those achieved by international high‐volume centres. Abstract : This 25‐year audit was to compare technical and oncological outcomes after oesophagectomy for cancer in southern New Zealand to national and international benchmarks. Our results suggest that despite being a low‐volume centre, peri‐operative morbidity, mortality and survival are comparable to those achieved in international high volume centres.