TY - JOUR

T1 - Textbook outcome following oesophagectomy for cancer

T2 - international cohort study

AU - Kamarajah, S. K.

AU - Nepogodiev, D.

AU - Hodson, J.

AU - Bundred, J. R.

AU - Gockel, I.

AU - Isik, A.

AU - Kidane, B.

AU - Mahendran, H. A.

AU - Negoi, I.

AU - Wijnhoven, B. P.L.

AU - Griffiths, Ewen A.

AU - Alderson, D.

AU - Jefferies, B.

AU - Siaw-Acheampong, K.

AU - Wanigasooriya, K.

AU - Whitehouse, T.

AU - Gjata, A.

AU - Moreno, J. I.

AU - Takeda, F. R.

AU - Castro, R. Guevara

AU - Harustiak, T.

AU - Bekele, A.

AU - Kechagias, A.

AU - Kennedy, A.

AU - Da Roit, A.

AU - Bagajevas, A.

AU - Azagra, J. S.

AU - Mejía-Fernández, L.

AU - El Kafsi, J.

AU - Sayyed, R. H.

AU - Sousa, M.

AU - Sampaio, A. S.

AU - Blanco, R.

AU - Wallner, B.

AU - Schneider, P. M.

AU - Hsu, P. K.

AU - Egberts, J. H.

AU - Migliore, M.

AU - Valmasoni, M.

AU - Medina-Franco, H.

AU - Lau, P. C.

AU - Okonta, K. E.

AU - Heisterkamp, J.

AU - Johnson, M.

AU - Achiam, M. P.

AU - Thorsteinsson, M.

AU - Siemsen, M.

AU - Tan, Y. R.

AU - Smith, B.

AU - Singh, A.

AU - Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative

N1 - Publisher Copyright: © 2022 The Author(s).

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

U2 - 10.1093/bjs/znac016

DO - 10.1093/bjs/znac016

M3 - Journal article

C2 - 35194634

AN - SCOPUS:85128800428

VL - 109

SP - 439

EP - 449

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 5

ER -