Textbook outcome following oesophagectomy for cancer: international cohort study

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • José Adelino Lobarinhas Barbosa

    Autor

Participantes de fora da FMUP

  • Kamarajah, SK
  • Evans, RPT
  • Nepogodiev, D
  • Hodson, J
  • Bundred, JR
  • Gockel,
  • Gossage, JA
  • Isik, A
  • Kidane, B
  • Mahendran, HA
  • Negoi,
  • Okonta, KE
  • Sayyed, R
  • Vohra, RS
  • Wijnhoven, BPL
  • Singh, P
  • Griffiths, EA
  • Alderson, D
  • Bundred, J
  • Gossage, J
  • Jefferies, B
  • McKay, S
  • Mohamed,
  • Siaw-Acheampong, K
  • Vohra, R
  • Wanigasooriya, K
  • Whitehouse, T
  • Gjata, A
  • Moreno, J
  • Takeda, FR
  • Castro, RG
  • Harustiak, T
  • Bekele, A
  • Kechagias, A
  • Kennedy, A
  • Da Roit, A
  • Bagajevas, A
  • Azagra, JS
  • Mejía-Fernández, L
  • El Kafsi, J
  • Sayyed, RH
  • Sousa, MM
  • Sampaio, AS
  • Blanco, R
  • Wallner, B
  • Schneider, PM
  • Hsu, PK
  • Gananadha, S
  • Wills,
  • Devadas, M
  • Duong, C
  • Talbot, M
  • Hii, MW
  • Jacobs, R
  • Andreollo, NA
  • Johnston, B
  • Darling, G
  • Isaza-Restrepo, A
  • Rosero, G
  • Arias-Amézquita, F
  • Raptis, D
  • Gaedcke, J
  • Reim, D
  • Izbicki, J
  • Egberts, JH
  • Dikinis, S
  • Kjaer, DW
  • Larsen, MH
  • Achiam, MP
  • Saarnio, J
  • Theodorou, D
  • Liakakos, T
  • Korkolis, DP
  • Robb, WB
  • Collins, C
  • Murphy, T
  • Reynolds, J
  • Tonini,
  • Migliore, M
  • Bonavina, L
  • Valmasoni, M
  • Bardini, R
  • Weindelmayer, J
  • Terashima, M
  • White, RE
  • Alghunaim, E
  • Elhadi, M
  • Leon-Takahashi, AM
  • Medina-Franco, H
  • Lau, PC
  • Heisterkamp, J
  • Rosman, C
  • van Hillegersberg, R
  • Beban, G
  • Gordon, A
  • Rossaak, J
  • Pal, KM
  • Qureshi, AU
  • Naqi, SA
  • Syed, AA
  • Vicente, CS
  • Leite, J
  • Freire, J
  • Casaca, R
  • Costa, RCT
  • Scurtu, RR
  • Mogoanta, SS
  • Bolca, C
  • Constantinoiu, S
  • Sekhniaidze, D
  • Bjelovic, M
  • So, JBY
  • Gacevski, G
  • Loureiro, C
  • Pera, M
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  • Gijón, MM
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  • Wong, LF
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  • Pucher, P
  • Athanasiou, A
  • Tan, B
  • Abdulrahman, M
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  • Chaparala, R
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  • Alasmar, MMA
  • Ackroyd, R
  • Patel, K
  • Tamhankar, A
  • Wyman, A
  • Walker, R
  • Grace, B
  • Abbassi, N
  • Slim, N
  • Ioannidi, L
  • Blackshaw, G
  • Havard, T
  • Escofet, X
  • Powell, A
  • Owera, A
  • Rashid, F
  • Jambulingam, P
  • Padickakudi, J
  • Ben-Younes, H
  • Mccormack, K
  • Makey, IA
  • Karush, MK
  • Seder, CW
  • Liptay, MJ
  • Chmielewski, G
  • Rosato, EL
  • Berger, AC
  • Zheng, R
  • Okolo, E
  • Singh, A
  • Scott, CD
  • Weyant, MJ
  • Mitchell, JD
  • Oesophago-Gastric Anastomotic Audi

Unidades de investigação

Abstract

Improvements in centralization, hospital resources (i.e. daily 24-hour on-call oesophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome. Understanding how these individual parameters help improve quality of patient care should be the focus of future research and will present a strong message globally to improve outcomes. Background Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Results Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Conclusion Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Dados da publicação

ISSN/ISSNe:
0007-1323, 1365-2168

British Journal of Surgery  Oxford University Press

Tipo:
Article
Páginas:
439-449
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 9

Citações Recebidas na Scopus: 19

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Keywords

  • Anastomosis, Surgical; Cohort Studies; Esophageal Neoplasms; Esophagectomy; Humans; Male; Minimally Invasive Surgical Procedures; Treatment Outcome; adult; anastomosis; Article; cancer chemotherapy; cancer grading; cancer surgery; Charlson Comorbidity Index; chemoradiotherapy; clinical outcome; cohort analysis; enteric feeding; esophagectomy; esophagus cancer; female; high income country; hospital readmission; human; length of stay; low income country; lymph node; major clinical study; male; middle income country; minimally invasive esophagectomy; mortality; neck; nutrition; open surgery; parenteral nutrition; physiotherapy; postoperative complication; prospective study; radiology; surgeon; thorax; transhiatal esophagectomy; tumor localization; uterine cervix; adverse event; esophagus resection; esophagus tumor; minimally invasive surgery; pathology; procedures; treatment outcome

Financiamento

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The Impact of Perioperative Chemotherapy on Survival in Patients With Gastric Signet Ring Cell Adenocarcinoma

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