Textbook outcome following oesophagectomy for cancer: international cohort study
Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative, S K Kamarajah, R.P.T. Evans, Dmitri Nepogodiev, J Hodson, James Bundred, Ines Gockel, James Gossage, A Isik, Biniam Kidane, H A Mahendran, Ionuţ Negoi, K E Okonta, Raza Sayyed, R van Hillegersberg, Ravinder Vohra, Bas P. L. Wijnhoven, Pritam Singh, Ewen A. Griffiths, S K Kamarajah, J Hodson, Ewen A. Griffiths, Derek Alderson, James Bundred, R.P.T. Evans, James Gossage, Ewen A. Griffiths, B. Jefferies, Sivesh K. Kamarajah, S McKay, I. Mohamed, Dmitri Nepogodiev, K Siaw-Acheampong, Pritam Singh, Richard van Hillegersberg, Ravinder Vohra, Kasun Wanigasooriya, Tony Whitehouse, Arben Gjata, J Moreno, Flávio Roberto Takeda, Biniam Kidane, R Guevara Castro, Tomáš Haruštiak, Abebe Bekele, Aristotelis Kechagias, Ines Gockel, Andrew Kennedy, Anna Da Roit, Aleksandras Bagajevas, J. S. Azagra, H A Mahendran, Lorelí Mejía-Fernández, Bas P. L. Wijnhoven, Jihène El Kafsi, Raza Sayyed, M Sousa M, Aline S. Sampaio, Ionuţ Negoi, R. Blanco, Bengt Wallner, Paul M. Schneider, Po‐Kuei Hsu, A Isik, Sivakumar Gananadha, Vanessa Wills, Michael Devadas, Chi N Duong, Michael Talbot, Michael W. Hii, Rebecca Jacobs, N.A Andreollo, Brian T. Johnston, Gail Darling, Andrés Isaza-Restrepo, G. Rosero, Fernando Arias, Dimitrios Raptis, Jochen Gaedcke, Daniel Reim, Jakob R. Izbicki, Jan‐Hendrik Egberts, Sarunas Dikinis, D W Kjaer, M. Larsen, Michael Patrick Achiam, Juha Saarnio, Dimitrios Theodorou, Theodore Liakakos, Dimitris P. Korkolis, William B. Robb, Chris Collins, Thomas J. Murphy, John V. Reynolds, Valeria Tonini, Marcello Migliore, Luigi Bonavina, Michele Valmasoni, Romeo Bardini, Jacopo Weindelmayer
Abstract
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.