Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)
Oesophago-Gastric Anastomosis Study Group, James Fergusson, Edwin Beenen, Charles A. Mosse, Jabeena Salim, S Cheah, Timothy Wright, M. P. Cerdeira, Patrick McQuillan, Mark P. Richardson, Han Liem, John Spillane, Myla Yacob, F. Albadawi, T. Thorpe, Ann F. Dingle, Carlos S. Cabalag, Ken Loi, OM Fisher, S Ward, Matthew Read, Mary Ann Johnson, R. Bassari, Hai T. Bui, Ivan Cecconello, RAA Sallum, JRM da Rocha, Lucia Rossetti Lopes, Valdir Tercioti, JDS Coelho, JAP Ferrer, Gordon Buduhan, Lijie Tan, Sadeesh Srinathan, P Shea, Jonathan Yeung, Frances Allison, Paul Carroll, Felipe Vargas-Barato, Felipe González, Joaquín Ortega, Laura Niño Torres, T.C. Beltrán-García, L. Castilla, Miguel A. Pineda, A. Bastidas, Jorge L. Gomez‐Mayorga, Natalia Cortés, C. Cetares, S Caceres, Sebastião Júnior Henrique Duarte, Alexandr Pazdro, Martin Snajdauf, H. Faltova, M. Sevcikova, Preben Bo Mortensen, Niels Katballe, T. Ingemann, Brianna C. Morten, I. Kruhlikava, AP Ainswort, N. M. Stilling, Jens Eckardt, Jens‐Christian Holm, Morten Thorsteinsson, Mette Siemsen, B Brandt, Berhanu Nega, E. Teferra, Ayalew Tizazu, Joonas H. Kauppila, Vesa Koivukangas, Sanna Meriläinen, Robert Gruetzmann, Christian Krautz, Georg F. Weber, Henriette Golcher, Georg Emons, Azadeh Azizian, Mara C. Ebeling, Stefan Niebisch, Nicole Kreuser, G. Albanese, J. Hesse, L. Volovnik, U. Boecher, Matthias Reeh, S. Triantafyllou, Dimitriοs Schizas, Adamantios Michalinos, E. Mpali, Maria Mpoura, Alexandros Charalabopoulos, Dimitrios K. Manatakis, Dimitrios Balalis, Jarlath Bolger, Chwanrow Baban, Achille Mastrosimone, O. J. McAnena, Aoife Quinn
Abstract
BACKGROUND: The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA). METHODS: The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up. RESULTS: The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013). CONCLUSION: Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.